Objective This study aimed to analyze the clinical efficacy of the Jianpi Shengxue tablet for treating renal anemia.Methods A total of 200 patients with renal anemia from December 2020 to December 2022 were enrolled a...Objective This study aimed to analyze the clinical efficacy of the Jianpi Shengxue tablet for treating renal anemia.Methods A total of 200 patients with renal anemia from December 2020 to December 2022 were enrolled and randomly divided into two groups.Patients in the control group were treated with polysaccharide-iron complex,and those in the experimental group were administered Jianpi Shengxue tablet.After 8 weeks of continuous treatment,the therapeutic outcomes regarding anemia were compared between the two groups.Results After treatment,the red blood cell(RBC)count,hematocrit(HCT),reticulocyte percentage(RET),ferritin(SF),serum iron(SI),transferrin saturation(TSAT),and serum albumin(ALB)all increased(P<0.01),and the clinical symptom score and total iron binding capacity decreased(P<0.01)in the experimental group.Moreover,the improvements in RBC,HCT,RET,SF,SI,TAST,ALB,and clinical symptoms(fatigue,anorexia,dull skin complexion,numbness of hands and feet)in the experimental group were significantly greater than those in the control group(P<0.05).The total effective rate for treating renal anemia was significantly higher in the experimental group than in the control group(P<0.01).Conclusion The Jianpi Shengxue tablet demonstrates efficacy in treating renal anemia,leading to significant improvements in the laboratory examination results and clinical symptoms of patients with renal anemia.展开更多
<strong>Introduction:</strong> Chronic renal failure (CRF) is defined as glomerular filtration rate (GFR) less than 60 ml/min/1.73m<sup>2</sup> for at least three (3) months. Anemia is one of i...<strong>Introduction:</strong> Chronic renal failure (CRF) is defined as glomerular filtration rate (GFR) less than 60 ml/min/1.73m<sup>2</sup> for at least three (3) months. Anemia is one of its most common complications. Anemia increases the risk factor for cardiovascular mortality by 18% per gram of hemoglobin loss. <strong>Objectives:</strong> To determine the prevalence and characteristics of this severe anemia, to determine the indications for transfusion, the complications related to this anemia, the evolution and the prognosis of these patients. <strong>Materials and Methods:</strong> This was a descriptive study with retrospective data collection over 18 months (January 1, 2017 to June 30, 2018) that included hospitalized CRF patients. Were included, non-dialyzed chronic renal failure patients with Hb ≤ 5 g/dl hospitalized during the said period. Not included were chronic renal failure patients with an Hb level ≥ 5 g/dl, those followed up and/or hospitalized outside the study period. <strong>Results:</strong> Among 1176 patients, 26 had severe anemia (Hb level ≤ 5 g/dl) on CRF, a prevalence of 2.21%. The mean age was 40 years ± 32.62 with extremes of 15 and 67 years. Seventeen women and 9 men. The etiology of chronic renal failure (CRF) was hypertensive vascular nephropathy in 50% of cases. CRF was end-stage in 18 patients (69.2%). The mean hemoglobin level was 4.10 g/dl ± 0.64 with extremes of 2 and 5 g/dl. The anemia was microcytic hypochromic in 50% and aregenerative (96.2%). The main symptoms were asthenia in 20 cases (76.9%), dizziness in 20 cases (76.9%), exertional dyspnea in 19 cases (73.1%). Signs of cardiac decompensation (n = 12) were jugular turgor 10 cases (38.5%), hepato-jugular reflux 06 cases (23.1%), mitral insufficiency murmur 06 cases (23.1%). The main complication was left ventricular hypertrophy 17 cases (77.3%). There was no correlation between anemia and sex (p = 0.291), age (p = 0.778), malaria (p = 0.158), etiology of CRF (p = 0.26). The evolution after treatment of anemia was favorable in 19 patients (73.1%), unfavorable in 02 patients (7.7%) and 05 deaths (19.2%). The deaths were of cardiovascular cause: left ventricular insufficiency 04 cases, stroke 01 case. <strong>Conclusion:</strong> Anemia is frequent in patients with chronic renal failure and remains an important risk factor for cardiovascular disease and poor general condition.展开更多
BACKGROUND:This study aims to evaluate the eff ect of continuous renal replacement therapy(CRRT)on inflammation-related anemia,iron metabolism,and the prognosis in sepsis patients with acute kidney injury(AKI).METHODS...BACKGROUND:This study aims to evaluate the eff ect of continuous renal replacement therapy(CRRT)on inflammation-related anemia,iron metabolism,and the prognosis in sepsis patients with acute kidney injury(AKI).METHODS:Sepsis patients with AKI were prospectively enrolled and randomized into the CRRT and control groups.The clinical and laboratory data on days 1,3 and 7 after intensive care unit(ICU)admission were collected.The serum interleukin(IL)-6,hepcidin,erythropoietin,ferritin,and soluble transferrin receptor(sTfR)were determined by enzyme-linked immunosorbent assay.The Sequential Organ Failure Assessment(SOFA)score and 28-day mortality were recorded.Data were analyzed using Pearson’s Chi-square test or Fisher’s exact test(categorical variables),and Mann-Whitney U-test or t-test(continuous variables).RESULTS:The hemoglobin and serum erythropoietin levels did not signifi cantly diff er between the CRRT and control groups though gradually decreased within the first week of ICU admission.On days 3 and 7,the serum IL-6,hepcidin,ferritin,and red blood cell distribution width significantly decreased in the CRRT group compared to the control group(all P<0.05).On day 7,the serum iron was significantly elevated in the CRRT group compared to the control group(P<0.05).However,the serum sTfR did not signifi cantly diff er between the groups over time.In addition,the SOFA scores were signifi cantly lower in the CRRT group compared to the control group on day 7.The 28-day mortality did not signifi cantly diff er between the control and CRRT groups(38.0%vs.28.2%,P=0.332).CONCLUSION:CRRT might have beneficial effects on the improvement in inflammationrelated iron metabolism and disease severity during the fi rst week of ICU admission but not anemia and 28-day mortality in sepsis patients with AKI.展开更多
BACKGROUNDMost cancer patients are accompanied by anemia, which will be more seriouswhen combined with end-stage renal disease (ESRD). At present, cancer-relatedanemia and renal anemia treatments mainly include erythr...BACKGROUNDMost cancer patients are accompanied by anemia, which will be more seriouswhen combined with end-stage renal disease (ESRD). At present, cancer-relatedanemia and renal anemia treatments mainly include erythropoiesis-stimulatingagents (ESAs), iron supplementation, and blood transfusion, but their effects areoften poor with several safety concerns. We have used roxadustat to treat anemiain a cancer patient with ESRD and achieved a successful outcome for the firsttime.CASE SUMMARYA 64-year-old man was diagnosed with right renal cancer (clear cell renal cellcarcinoma). He did not receive surgery or radiotherapy before admission. He wastreated with oral soltan (sunitinib malate) on April 18, 2017. During oral chemotherapy,he had numerous complications, including anemia, hypertension,thyroid hypofunction, skin pigment loss, and renal function deterioration. At last,he progressed to ESRD and began hemodialysis treatment. We initially treated thepatient with high-dose ESAs, iron supplementation, adequate dialysis, and evenblood transfusion, but his anemia did not improve. Roxadustat is a newlydeveloped drug for renal anemia treatment, but not for cancer-related anemia, letalone to treat anemia in cancer patients with ESRD. We prescribed oral roxadustatto the patient. After a period, his hemoglobin gradually increased. He did nothave obvious discomfort symptoms, and his tumor did not progress significantly.CONCLUSIONOral roxadustat could achieve good results in treating anemia in cancer patients with ESRD.展开更多
This study compared Sheng Xue Ning(SXN)tablets with ferrous succinate(FS)tablets in terms of their efficacy for the treatment of iron-deficient renal anemia and safety in patients subject to maintenance hemodialysis(M...This study compared Sheng Xue Ning(SXN)tablets with ferrous succinate(FS)tablets in terms of their efficacy for the treatment of iron-deficient renal anemia and safety in patients subject to maintenance hemodialysis(MHD).A total of 94 patients undergoing MHD were randomly assigned to an experiment group(receiving oral SXN tablcts,SXN group)and a control group(orally given FS tablets,FS group)and followed up for 12 weeks.Erythropoietin(EPO)was used in both groups.The eficacy was assessed by detecting the subsequent changes in hemoglobin(Hb),serum iron(SI),SF and transferrin saturation(TSAT).At the 12th week,Hb and TSAT levels in both groups were significantly increased compared to those in the screening period(P<0.05).However,no significant difference in Hb and TSAT was found between the two groups.The average weekly EPO dosage used was lower in SXN group than in FS group(P<0.05)at the 10th week and the 12th week.Our study showed that SXN tablets can effectively ameliorate renal anemia and keep iron metabolism stable in MHD patients,and its efficacy is virtually close to that of FS tablets.Meanwhile,SXN tablets can reduce the dosage of EPO and have a good safety profile.展开更多
Background: Anemia is a common complication of end-stage renal disease (ESRD) and is effectively managed by Erythropoietin Stimulating Agents (ESAs) and intravenous iron therapy. Management of anemia in ESRD patients ...Background: Anemia is a common complication of end-stage renal disease (ESRD) and is effectively managed by Erythropoietin Stimulating Agents (ESAs) and intravenous iron therapy. Management of anemia in ESRD patients with myelodysplastic syndrome (MDS) poses a unique challenge. ESAs even at extremely high doses do not result in a desired response, especially if the patients are iron-overloaded. Case: A 72-year-old man with history of ESRD and MDS on hemodialysis since September 2009 was severely anemic requiring massive doses of ESA in excess of 90,000 units/week. Iron saturation was consistently >60%;ferritin was >2500. Desferrioxamine (DFO) 125 mg IV/week was begun in November 2010. His PRBC transfusion and ESA requirements declined after the initiation of this therapy. He had 33 ER visits for PRBC transfusions (1 - 3 transfusions/visit) from September 2009 to November 2010 (average: 2.35/month), which decreased to 18 visits in 20 months (average: 0.9/month) after getting DFO. Conclusion: We report a case of MDS with ESRD on hemodialysis where anemia was managed with Desferrioxamine therapy along with ESA, after which it was noted that there was a significant reduction in the number of PRBC transfusions that the patient received along with a decrease in ESA requirements and a decrease in number of hospitalizations, which in the long term could be cost effective.展开更多
Aim: To determine the incidence of anemia in type-2 diabetic patients with normal renal function and assess the association of other factors related to diabetes with the risk of anemia. Methods: The study group compri...Aim: To determine the incidence of anemia in type-2 diabetic patients with normal renal function and assess the association of other factors related to diabetes with the risk of anemia. Methods: The study group comprised 72 patients with type-2 diabetes. Patients were divided into groups according to glycemic control, gender and age. Serum creatinine, hematocrit, hemoglobin concentration, blood glucose and glycated hemoglobin (HbA1c) of subjects were measured. The presence of anemia was defined by a he- moglobin level 7.5%) compared to those with controlled diabetes (≤7.5%) and in patients of age ≥ 60 yrs compared to those of age < 60 yrs (p < 0.05). The odds of anemia was similar in males and females (p = 0.26). Conclusion: This study indicated that poor glycemic control and old age are associated with the incidence of anemia in type-2 diabetics with normal renal function. Our findings suggest that treatment criteria for diabetes should include routine hematological tests and take into consideration the inevitable consequences of ageing, and poor glycemic control.展开更多
Objective: To investigate the effect of high throughput hemodialysis on soluble transferrin receptor in hemodialysis patients and the improvement of renal anemia. Methods: 132 patients receiving maintenance hemodialys...Objective: To investigate the effect of high throughput hemodialysis on soluble transferrin receptor in hemodialysis patients and the improvement of renal anemia. Methods: 132 patients receiving maintenance hemodialysis in our hospital from July 2017 to July 2019 were selected and divided into control group and observation group according to the random number table method, with 66 cases each. The observation group was treated with high-flux hemodialysis, while the control group was treated with low-flux hemodialysis for 6 months. Compare two groups before and after treatment serum beta 2 microglobulin (beta 2 - MG), serum creatinine (Scr), blood urea nitrogen (BUN) level, anemia related index [red blood cells deposited (HCT), hemoglobin (Hb), reticulocyte percentage (Ret%)], iron metabolism index [serum ferritin (SF), transferrin saturation (TSAT)、Hepcidin(Hepc)], soluble transferrin receptor (sTfR) levels and adverse reactions. Results: the levels of 2-MG, Scr and BUN in the two groups before treatment were compared (P>0.05). After treatment, Scr and BUN levels in the two groups were significantly decreased (P<0.05), but were compared between the two groups (P>0.05). The level of 2-MG in the observation group was lower than that in the control group (P<0.05). Before treatment, sTfR, Hb, HCT level and Ret% of the two groups were compared(P>0.05). After treatment, Hb and HCT levels in the observation group were higher than those in the control group, while Ret% were lower than those in the control group, (P<0.05). Before treatment, the levels of ST、TAST、sTfR and Hepc in the two groups were compared (P>0.05). After treatment, the level of ST and TAST in the observation group was higher than that in the control group, The levels of sTfR and Hepc were lower than the control group (P<0.05). The overall incidence of adverse reactions in the observation group (8.93%) was lower than that in the control group (10.14%), with no significant difference (P>0.05). Conclusion: The high-throughput hemodialysis department significantly improved renal anemia in hemodialysis patients, reduced serum sTfR level, and had fewer adverse reactions and higher safety.展开更多
Objective: To study the correlation of serum vitamin C content with renal anemia, oxidative stress and microinflammatory state in patients with peritoneal dialysis. Methods: A total of 96 patients undergoing peritonea...Objective: To study the correlation of serum vitamin C content with renal anemia, oxidative stress and microinflammatory state in patients with peritoneal dialysis. Methods: A total of 96 patients undergoing peritoneal dialysis in the First Affiliated Hospital of Soochow University between January 2016 and January 2017 were selected as the peritoneal dialysis group, and 50 healthy volunteers receiving physical examination in the First Affiliated Hospital of Soochow University during the same period were selected as the normal control group. The contents of VitC as well as renal anemia, oxidative stress and microinflammation-related indexes in peripheral blood of two groups of subjects were detected, and Pearson test was used to evaluate the correlation of serum VitC content with renal anemia, oxidative stress and microinflammatory state in patients with peritoneal dialysis. Results: VitC content in peripheral blood of peritoneal dialysis group was lower than that of normal control group;renal anemia-related indexes Hb, RBC and TIBC levels in peripheral blood were lower than those of normal control group;oxidative stress indexes LHP, MPO and AOPPs contents in serum were higher than those of control group while SOD and GSH-Px contents were lower than those of control group;inflammatory factors CRP, IL-6, IL-8, IL-10 and IL-13 contents in serum were higher than those of normal control group. VitC content in serum of patients with peritoneal dialysis was positively correlated with Hb, RBC, TIBC, SOD and GSH-Px levels, and negatively correlated with LHP, MPO, AOPPs, CRP, IL-6, IL-8, IL-10 and IL-13 contents. Conclusion: Serum VitC content is lower in patients with peritoneal dialysis, and the specific content is directly correlated with the severity of renal anemia, oxidative stress and microinflammatory state.展开更多
Objective:To analyze the short-term curative effect of roxadustat in the treatment of renal anemia in patients with peritoneal dialysis.Methods:70 patients with peritoneal dialysis renal anemia admitted to the dialysi...Objective:To analyze the short-term curative effect of roxadustat in the treatment of renal anemia in patients with peritoneal dialysis.Methods:70 patients with peritoneal dialysis renal anemia admitted to the dialysis department of our hospital from March 2021-March 2023 were selected as research objects,divided into a research group and a reference group according to random number drawing method,with each group consisting of 35 cases.The patients in the research group were treated with roxadustat,and those in the reference group were treated with recombinant human erythropoietin.The total efficacy,anemia index,iron metabolism index,and occurrence of adverse reactions were compared between the two groups.Results:The total efficacy of the treatment received in the research group was significantly higher than that in the reference group(P<0.05).In terms of anemia indicators,there was no statistically significant difference between the hemoglobin(Hb),the red blood cell(RBC),and the hematocrit(HCT)of both groups(P>0.05)before treatment.After treatment,the anemia indicators of the patients in the research group were significantly better than those in the reference group,(P<0.05).In terms of iron metabolism,before treatment,there was no significant difference between the total iron-binding capacity(TIBC),the transferrin(TRF),the ferritin(FER),and iron(Fe)of both groups(P>0.05).After treatment,the research group’s iron metabolism indicators were significantly better than those of the reference group(P<0.05).The incidence of adverse reactions in the research group was significantly lower than that in the reference group(P<0.05).Conclusion:The short-term curative effect of roxadustat in the treatment of peritoneal dialysis patients was demonstrated through this study,making it a viable treatment option.展开更多
Adrenal hematoma is a rare condition with highly variable clinical manifestations, ranging from completely asymptomatic cases to specific signs. Abdominal ultrasound is the key examination for diagnosing and monitorin...Adrenal hematoma is a rare condition with highly variable clinical manifestations, ranging from completely asymptomatic cases to specific signs. Abdominal ultrasound is the key examination for diagnosing and monitoring neonates. We present a case of adrenal hematoma diagnosed following neonatal anemia.展开更多
BACKGROUND Congenital sideroblastic anemia(CSA)is a rare and heterogeneous group of genetic disorders.Conventional treatment include pyridoxine(vitamin B6)and allogeneic hematopoietic stem cell transplantation(allo-HS...BACKGROUND Congenital sideroblastic anemia(CSA)is a rare and heterogeneous group of genetic disorders.Conventional treatment include pyridoxine(vitamin B6)and allogeneic hematopoietic stem cell transplantation(allo-HSCT),and can alleviate anemia in the majority of cases.Nevertheless,some CSA cases remain unresponsive to pyridoxine or are unable to undergo allo-HSCT.Novel management approaches is necessary to be developed.To explore the response of luspatercept in treating congenital sideroblastic anemia.CASE SUMMARY We share our experience in luspatercept in a 4-year-old male patient with CSA.Luspatercept was administered subcutaneously at doses of 1.0 mg/kg/dose to 1.25 mg/kg/dose every 3 wk,three consecutive doses,evaluating the hematological response.Luspatercept leading to a significant improvement in the patient's anemia.The median hemoglobin during the overall treatment with three doses of luspatercept was 90(75-101)g/L,the median absolute reticulocyte count was 0.0593(0.0277-0.1030)×10^(12)/L,the median serum ferritin was 304.3(234.4-399)ng/mL,and the median lifespan of mature red blood cells was 80(57-92)days.Notably,no adverse reactions,such as headaches,dizziness,vomiting,joint pain,or back pain,were observed during the treatment period.CONCLUSION We believe that luspatercept might emerge as a viable therapeutic option for the maintenance treatment of CSA or as a bridging treatment option before hematopoietic stem cell transplantation.展开更多
Renal anastomotic hemangioma(AH)is a rare,benign vascular tumor with unique histopathological features,a disease that is clinically rare,and existing clinical cases offer different treatment options.As reported in the...Renal anastomotic hemangioma(AH)is a rare,benign vascular tumor with unique histopathological features,a disease that is clinically rare,and existing clinical cases offer different treatment options.As reported in the text,this is a very unusual case of renal AH with AH secondary to residual renal tissue after renal clear cell carcinoma,describing a rare renal AH and a history of renal clear cell carcinoma,including ultrasound,computed tomography and magnetic re-sonance imaging.However,the available imaging data and the literature do not provide an effective basis for the diagnosis of the disease,raising the lack of un-derstanding and misdiagnosis,where the patient eventually underwent neph-rectomy,but the author is not the most appropriate surgical treatment.The po-stoperative pathological results of the patient are benign lesions,and it is unde-niable that nephrectomy is suspected to be overtreated.By reading the literature,we provide different insights into the treatment of the patient,and we hope that this paper can provide some help for the future clinical diagnosis and treatment.展开更多
BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with si...BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with significant long-term morbidity,and histological abnormalities such as crescentic glomerulonephritis are infrequently reported.PSAGN has also been linked to late-onset chronic kidney disease in some populations due to high levels of proteinuria.METHODS This prospective observational study was conducted at Lady Ridgeway Hospital(Colombo,Sri Lanka)over 15 months.Children with PSAGN were enrolled based on clinical and laboratory criteria.Persistent proteinuria≥2+for 2 weeks and serum creatinine>100μmol/L warranted renal biopsy,assessed via light microscopy and immunofluorescence.Normalization of complement 3(C3)within 6 to 8 weeks was required for inclusion.Data on clinical features,urine protein levels,and renal function were collected from patient records,and potential associations were analysed using Statistical Package for the Social Sciences and R language for statistical computing.Ethical approval was obtained from the Ethical Review Committee,Lady Ridgeway Hospital for Children(Ref No:LRH/ERC/2021/60).RESULTS Forty-four patients were recruited.There were 27(61.4%)male patients and 17(38.6%)female patients.Thirty-seven(84%)of them were above 5 years of age.Twenty(45%)patients had a history of skin sepsis,and eighteen(41%)had a history of throat infection.Among patients with proteinuria≥2+,53%had serum creatinine>100µmol/L,while among those with proteinuria<2+,7%had serum creatinine>100µmol/L.The association of high-degree proteinuria with elevated serum creatinine was significant(χ²=7.8,P=0.005)in PSAGN.The odds ratio of the logistic regression model was 1.049(95%confidence interval:1.003-1.098),indicating a positive direction with statistically significant association(P=0.037).There was no significant association between proteinuria and the degree of hypertension or estimated creatinine clearance.Ten children underwent renal biopsy.Crescents(less than 50%)were demonstrated in five children,while three children had typical diffuse proliferative glomer-ulonephritis.One child had severe acute tubular necrosis,and another had crescentic glomerulonephritis(crescents>50%).The immunofluorescence studies revealed deposition of immunoglobulin G and C3 in all biopsy specimens.CONCLUSION High-degree proteinuria was significantly associated with elevated serum creatinine(>100μmol/L)in children with PSAGN.The majority of children with persistent proteinuria≥2+for more than 2 weeks and the highest recorded serum creatinine>100μmol/L had atypical renal histological findings.展开更多
Iron deficiency anemia(IDA)continues to be a global public health problem.Oral iron is the universally accepted first-line therapy,and most children have a prompt and favorable response to oral formulations.In subsets...Iron deficiency anemia(IDA)continues to be a global public health problem.Oral iron is the universally accepted first-line therapy,and most children have a prompt and favorable response to oral formulations.In subsets of children who fail to respond due to intolerance,poor adherence,or inadequate intestinal absorption,parenteral iron is indicated.Despite numerous studies in adults with IDA of diverse etiologies,pediatric studies on parenteral iron use are very limited.Although mostly retrospective and small,these studies have documented the efficacy and safety profile of intravenous iron formulations.In this editorial the author comments on the most important published data and underscores the need to seriously consider parenteral iron use in children unresponsive to oral therapy.展开更多
BACKGROUND Exertional heat stroke(EHS)is a critical condition arising from prolonged physical exertion in high temperatures that typically presents with normal hemoglobin levels.However,atypical presentations can also...BACKGROUND Exertional heat stroke(EHS)is a critical condition arising from prolonged physical exertion in high temperatures that typically presents with normal hemoglobin levels.However,atypical presentations can also occur,leading to significant complications such as hemolytic anemia and organ dysfunction.CASE SUMMARY This case report describes a male patient who experienced moderate-to-severe anemia that was difficult to correct,with a confirmed diagnosis of microangiopathic hemolytic anemia accompanying multiple organ dysfunction syndrome,indicative of critical EHS.Despite intensive resuscitation efforts,the patient’s condition deteriorated,necessitating admission to the intensive care unit for advanced management.CONCLUSION This case highlights the importance of recognizing atypical presentations of EHS,particularly that with significant hemolytic anemia and concurrent organ failure.Clinicians should maintain a high level of suspicion for these complications in patients displaying symptoms of heat-related illness,especially when caused by strenuous activity,as early diagnosis and intervention are crucial to improve patient outcomes.展开更多
Alectinib is a selective Anaplastic Lymphoma Kinase (ALK) tyrosine kinase inhibitor used as standard therapy for ALK-rearranged lung adenocarcinoma. Hemolytic anemia is considered a rare but significant adverse event ...Alectinib is a selective Anaplastic Lymphoma Kinase (ALK) tyrosine kinase inhibitor used as standard therapy for ALK-rearranged lung adenocarcinoma. Hemolytic anemia is considered a rare but significant adverse event of alectinib. Here, we report the case of a 78-year-old female with advanced ALK rearrangement-positive lung adenocarcinoma who developed grade 4 drug-induced hemolytic anemia after receiving alectinib as first-line therapy. We discontinued alectinib treatment and switched to brigatinib. As a result, anemia improved without recurrence of lung adenocarcinoma over one year.展开更多
Neonatal adrenal hemorrhage is frequently associated with birth trauma, perinatal asphyxia, intrauterine infection, coagulation defects and thromboembolism. It has varied clinical presentation depending on degree of h...Neonatal adrenal hemorrhage is frequently associated with birth trauma, perinatal asphyxia, intrauterine infection, coagulation defects and thromboembolism. It has varied clinical presentation depending on degree of hemorrhage and amount of adrenal cortex compromised by hemorrhage. The most common clinical presentations are persistent jaundice and flank mass. We report a case of left sided adrenal hemorrhage in a breech delivered male neonate with perinatal asphyxia presented with anemia and fever. On further evaluation, he was also having moderate communicating hydrocephalus secondary to intraventricular hemorrhage. The adrenal hemorrhage was managed conservatively. Subsequent abdominal ultrasound showed resolving adrenal hemorrhage. Right ventriculoperitoneal shunt was done for hydrocephalus. Postoperative course was uneventful. The patient is asymptomatic at follow-up.展开更多
It was demonstrated pathologically that the histological structures of kidneys were impaired after subcutaneous injection of gentamycin for 16 consecutive days in rats. Laboratory parameters showed that serum blood ur...It was demonstrated pathologically that the histological structures of kidneys were impaired after subcutaneous injection of gentamycin for 16 consecutive days in rats. Laboratory parameters showed that serum blood urea nitrogen(BUN) and creatinine (Cr) elevated, while the indices of the erythrogenic line reduced markedly, and erythropoietin (EPO) was not detectable by ELISA. When the rats received recombinant human erythropoietin (rhEPO) for 5 d, the level of EPO in serum went up, and the indices of reticulocyte, red blood cell (RBC),hemoglobin (Hb) and hematocrit (Hct) improved rapidly, of which the response of reticulocyte was most sensitive. The results suggested that the erythrogenic function of the bone marrow in rats was enhanced after the stimulation of rhEPO, and the effect of rhEPO was dose dependent.展开更多
Most anemia is related to the digestive system by dietary deficiency, malabsorption, or chronic bleeding. We review the World Health Organization definition of anemia, its morphological classifi cation (microcytic, ma...Most anemia is related to the digestive system by dietary deficiency, malabsorption, or chronic bleeding. We review the World Health Organization definition of anemia, its morphological classifi cation (microcytic, macrocytic and normocytic) and pathogenic classi-fication (regenerative and hypo regenerative), and integration of these classifications. Interpretation of laboratory tests is included, from the simplest (blood count, routine biochemistry) to the more specific (iron metabolism, vitamin B12, folic acid, reticulocytes, erythropoietin, bone marrow examination and Schilling test). In the text and various algorithms, we propose a hierarchical and logical way to reach a diagnosis as quickly as possible, by properly managing the medical interview, physical examination, appropriate laboratory tests, bone marrow examination, and other comple-mentary tests. The prevalence is emphasized in all sections so that the gastroenterologist can direct the diagnosis to the most common diseases, although the tables also include rare diseases. Digestive diseases potentially causing anemia have been studied in preference, but other causes of anemia have been included in the text and tables. Primitive hematological diseases that cause anemia are only listed, but are not discussed in depth. The last section is dedicated to simplifying all items discussed above, using practical rules to guide diagnosis and medical care with the greatest economy of resources and time.展开更多
基金financially supported by the National Natural Science Foundation of China(No.82170701).
文摘Objective This study aimed to analyze the clinical efficacy of the Jianpi Shengxue tablet for treating renal anemia.Methods A total of 200 patients with renal anemia from December 2020 to December 2022 were enrolled and randomly divided into two groups.Patients in the control group were treated with polysaccharide-iron complex,and those in the experimental group were administered Jianpi Shengxue tablet.After 8 weeks of continuous treatment,the therapeutic outcomes regarding anemia were compared between the two groups.Results After treatment,the red blood cell(RBC)count,hematocrit(HCT),reticulocyte percentage(RET),ferritin(SF),serum iron(SI),transferrin saturation(TSAT),and serum albumin(ALB)all increased(P<0.01),and the clinical symptom score and total iron binding capacity decreased(P<0.01)in the experimental group.Moreover,the improvements in RBC,HCT,RET,SF,SI,TAST,ALB,and clinical symptoms(fatigue,anorexia,dull skin complexion,numbness of hands and feet)in the experimental group were significantly greater than those in the control group(P<0.05).The total effective rate for treating renal anemia was significantly higher in the experimental group than in the control group(P<0.01).Conclusion The Jianpi Shengxue tablet demonstrates efficacy in treating renal anemia,leading to significant improvements in the laboratory examination results and clinical symptoms of patients with renal anemia.
文摘<strong>Introduction:</strong> Chronic renal failure (CRF) is defined as glomerular filtration rate (GFR) less than 60 ml/min/1.73m<sup>2</sup> for at least three (3) months. Anemia is one of its most common complications. Anemia increases the risk factor for cardiovascular mortality by 18% per gram of hemoglobin loss. <strong>Objectives:</strong> To determine the prevalence and characteristics of this severe anemia, to determine the indications for transfusion, the complications related to this anemia, the evolution and the prognosis of these patients. <strong>Materials and Methods:</strong> This was a descriptive study with retrospective data collection over 18 months (January 1, 2017 to June 30, 2018) that included hospitalized CRF patients. Were included, non-dialyzed chronic renal failure patients with Hb ≤ 5 g/dl hospitalized during the said period. Not included were chronic renal failure patients with an Hb level ≥ 5 g/dl, those followed up and/or hospitalized outside the study period. <strong>Results:</strong> Among 1176 patients, 26 had severe anemia (Hb level ≤ 5 g/dl) on CRF, a prevalence of 2.21%. The mean age was 40 years ± 32.62 with extremes of 15 and 67 years. Seventeen women and 9 men. The etiology of chronic renal failure (CRF) was hypertensive vascular nephropathy in 50% of cases. CRF was end-stage in 18 patients (69.2%). The mean hemoglobin level was 4.10 g/dl ± 0.64 with extremes of 2 and 5 g/dl. The anemia was microcytic hypochromic in 50% and aregenerative (96.2%). The main symptoms were asthenia in 20 cases (76.9%), dizziness in 20 cases (76.9%), exertional dyspnea in 19 cases (73.1%). Signs of cardiac decompensation (n = 12) were jugular turgor 10 cases (38.5%), hepato-jugular reflux 06 cases (23.1%), mitral insufficiency murmur 06 cases (23.1%). The main complication was left ventricular hypertrophy 17 cases (77.3%). There was no correlation between anemia and sex (p = 0.291), age (p = 0.778), malaria (p = 0.158), etiology of CRF (p = 0.26). The evolution after treatment of anemia was favorable in 19 patients (73.1%), unfavorable in 02 patients (7.7%) and 05 deaths (19.2%). The deaths were of cardiovascular cause: left ventricular insufficiency 04 cases, stroke 01 case. <strong>Conclusion:</strong> Anemia is frequent in patients with chronic renal failure and remains an important risk factor for cardiovascular disease and poor general condition.
基金funded by the Shenzhen Key Medical Discipline Construction Fund(S ZXK046)the National Nature Science Foundation of China(81571869).
文摘BACKGROUND:This study aims to evaluate the eff ect of continuous renal replacement therapy(CRRT)on inflammation-related anemia,iron metabolism,and the prognosis in sepsis patients with acute kidney injury(AKI).METHODS:Sepsis patients with AKI were prospectively enrolled and randomized into the CRRT and control groups.The clinical and laboratory data on days 1,3 and 7 after intensive care unit(ICU)admission were collected.The serum interleukin(IL)-6,hepcidin,erythropoietin,ferritin,and soluble transferrin receptor(sTfR)were determined by enzyme-linked immunosorbent assay.The Sequential Organ Failure Assessment(SOFA)score and 28-day mortality were recorded.Data were analyzed using Pearson’s Chi-square test or Fisher’s exact test(categorical variables),and Mann-Whitney U-test or t-test(continuous variables).RESULTS:The hemoglobin and serum erythropoietin levels did not signifi cantly diff er between the CRRT and control groups though gradually decreased within the first week of ICU admission.On days 3 and 7,the serum IL-6,hepcidin,ferritin,and red blood cell distribution width significantly decreased in the CRRT group compared to the control group(all P<0.05).On day 7,the serum iron was significantly elevated in the CRRT group compared to the control group(P<0.05).However,the serum sTfR did not signifi cantly diff er between the groups over time.In addition,the SOFA scores were signifi cantly lower in the CRRT group compared to the control group on day 7.The 28-day mortality did not signifi cantly diff er between the control and CRRT groups(38.0%vs.28.2%,P=0.332).CONCLUSION:CRRT might have beneficial effects on the improvement in inflammationrelated iron metabolism and disease severity during the fi rst week of ICU admission but not anemia and 28-day mortality in sepsis patients with AKI.
文摘BACKGROUNDMost cancer patients are accompanied by anemia, which will be more seriouswhen combined with end-stage renal disease (ESRD). At present, cancer-relatedanemia and renal anemia treatments mainly include erythropoiesis-stimulatingagents (ESAs), iron supplementation, and blood transfusion, but their effects areoften poor with several safety concerns. We have used roxadustat to treat anemiain a cancer patient with ESRD and achieved a successful outcome for the firsttime.CASE SUMMARYA 64-year-old man was diagnosed with right renal cancer (clear cell renal cellcarcinoma). He did not receive surgery or radiotherapy before admission. He wastreated with oral soltan (sunitinib malate) on April 18, 2017. During oral chemotherapy,he had numerous complications, including anemia, hypertension,thyroid hypofunction, skin pigment loss, and renal function deterioration. At last,he progressed to ESRD and began hemodialysis treatment. We initially treated thepatient with high-dose ESAs, iron supplementation, adequate dialysis, and evenblood transfusion, but his anemia did not improve. Roxadustat is a newlydeveloped drug for renal anemia treatment, but not for cancer-related anemia, letalone to treat anemia in cancer patients with ESRD. We prescribed oral roxadustatto the patient. After a period, his hemoglobin gradually increased. He did nothave obvious discomfort symptoms, and his tumor did not progress significantly.CONCLUSIONOral roxadustat could achieve good results in treating anemia in cancer patients with ESRD.
文摘This study compared Sheng Xue Ning(SXN)tablets with ferrous succinate(FS)tablets in terms of their efficacy for the treatment of iron-deficient renal anemia and safety in patients subject to maintenance hemodialysis(MHD).A total of 94 patients undergoing MHD were randomly assigned to an experiment group(receiving oral SXN tablcts,SXN group)and a control group(orally given FS tablets,FS group)and followed up for 12 weeks.Erythropoietin(EPO)was used in both groups.The eficacy was assessed by detecting the subsequent changes in hemoglobin(Hb),serum iron(SI),SF and transferrin saturation(TSAT).At the 12th week,Hb and TSAT levels in both groups were significantly increased compared to those in the screening period(P<0.05).However,no significant difference in Hb and TSAT was found between the two groups.The average weekly EPO dosage used was lower in SXN group than in FS group(P<0.05)at the 10th week and the 12th week.Our study showed that SXN tablets can effectively ameliorate renal anemia and keep iron metabolism stable in MHD patients,and its efficacy is virtually close to that of FS tablets.Meanwhile,SXN tablets can reduce the dosage of EPO and have a good safety profile.
文摘Background: Anemia is a common complication of end-stage renal disease (ESRD) and is effectively managed by Erythropoietin Stimulating Agents (ESAs) and intravenous iron therapy. Management of anemia in ESRD patients with myelodysplastic syndrome (MDS) poses a unique challenge. ESAs even at extremely high doses do not result in a desired response, especially if the patients are iron-overloaded. Case: A 72-year-old man with history of ESRD and MDS on hemodialysis since September 2009 was severely anemic requiring massive doses of ESA in excess of 90,000 units/week. Iron saturation was consistently >60%;ferritin was >2500. Desferrioxamine (DFO) 125 mg IV/week was begun in November 2010. His PRBC transfusion and ESA requirements declined after the initiation of this therapy. He had 33 ER visits for PRBC transfusions (1 - 3 transfusions/visit) from September 2009 to November 2010 (average: 2.35/month), which decreased to 18 visits in 20 months (average: 0.9/month) after getting DFO. Conclusion: We report a case of MDS with ESRD on hemodialysis where anemia was managed with Desferrioxamine therapy along with ESA, after which it was noted that there was a significant reduction in the number of PRBC transfusions that the patient received along with a decrease in ESA requirements and a decrease in number of hospitalizations, which in the long term could be cost effective.
文摘Aim: To determine the incidence of anemia in type-2 diabetic patients with normal renal function and assess the association of other factors related to diabetes with the risk of anemia. Methods: The study group comprised 72 patients with type-2 diabetes. Patients were divided into groups according to glycemic control, gender and age. Serum creatinine, hematocrit, hemoglobin concentration, blood glucose and glycated hemoglobin (HbA1c) of subjects were measured. The presence of anemia was defined by a he- moglobin level 7.5%) compared to those with controlled diabetes (≤7.5%) and in patients of age ≥ 60 yrs compared to those of age < 60 yrs (p < 0.05). The odds of anemia was similar in males and females (p = 0.26). Conclusion: This study indicated that poor glycemic control and old age are associated with the incidence of anemia in type-2 diabetics with normal renal function. Our findings suggest that treatment criteria for diabetes should include routine hematological tests and take into consideration the inevitable consequences of ageing, and poor glycemic control.
基金Zhongshan Municipal Science and Technology Plan Project(No.2017B1061)
文摘Objective: To investigate the effect of high throughput hemodialysis on soluble transferrin receptor in hemodialysis patients and the improvement of renal anemia. Methods: 132 patients receiving maintenance hemodialysis in our hospital from July 2017 to July 2019 were selected and divided into control group and observation group according to the random number table method, with 66 cases each. The observation group was treated with high-flux hemodialysis, while the control group was treated with low-flux hemodialysis for 6 months. Compare two groups before and after treatment serum beta 2 microglobulin (beta 2 - MG), serum creatinine (Scr), blood urea nitrogen (BUN) level, anemia related index [red blood cells deposited (HCT), hemoglobin (Hb), reticulocyte percentage (Ret%)], iron metabolism index [serum ferritin (SF), transferrin saturation (TSAT)、Hepcidin(Hepc)], soluble transferrin receptor (sTfR) levels and adverse reactions. Results: the levels of 2-MG, Scr and BUN in the two groups before treatment were compared (P>0.05). After treatment, Scr and BUN levels in the two groups were significantly decreased (P<0.05), but were compared between the two groups (P>0.05). The level of 2-MG in the observation group was lower than that in the control group (P<0.05). Before treatment, sTfR, Hb, HCT level and Ret% of the two groups were compared(P>0.05). After treatment, Hb and HCT levels in the observation group were higher than those in the control group, while Ret% were lower than those in the control group, (P<0.05). Before treatment, the levels of ST、TAST、sTfR and Hepc in the two groups were compared (P>0.05). After treatment, the level of ST and TAST in the observation group was higher than that in the control group, The levels of sTfR and Hepc were lower than the control group (P<0.05). The overall incidence of adverse reactions in the observation group (8.93%) was lower than that in the control group (10.14%), with no significant difference (P>0.05). Conclusion: The high-throughput hemodialysis department significantly improved renal anemia in hemodialysis patients, reduced serum sTfR level, and had fewer adverse reactions and higher safety.
文摘Objective: To study the correlation of serum vitamin C content with renal anemia, oxidative stress and microinflammatory state in patients with peritoneal dialysis. Methods: A total of 96 patients undergoing peritoneal dialysis in the First Affiliated Hospital of Soochow University between January 2016 and January 2017 were selected as the peritoneal dialysis group, and 50 healthy volunteers receiving physical examination in the First Affiliated Hospital of Soochow University during the same period were selected as the normal control group. The contents of VitC as well as renal anemia, oxidative stress and microinflammation-related indexes in peripheral blood of two groups of subjects were detected, and Pearson test was used to evaluate the correlation of serum VitC content with renal anemia, oxidative stress and microinflammatory state in patients with peritoneal dialysis. Results: VitC content in peripheral blood of peritoneal dialysis group was lower than that of normal control group;renal anemia-related indexes Hb, RBC and TIBC levels in peripheral blood were lower than those of normal control group;oxidative stress indexes LHP, MPO and AOPPs contents in serum were higher than those of control group while SOD and GSH-Px contents were lower than those of control group;inflammatory factors CRP, IL-6, IL-8, IL-10 and IL-13 contents in serum were higher than those of normal control group. VitC content in serum of patients with peritoneal dialysis was positively correlated with Hb, RBC, TIBC, SOD and GSH-Px levels, and negatively correlated with LHP, MPO, AOPPs, CRP, IL-6, IL-8, IL-10 and IL-13 contents. Conclusion: Serum VitC content is lower in patients with peritoneal dialysis, and the specific content is directly correlated with the severity of renal anemia, oxidative stress and microinflammatory state.
文摘Objective:To analyze the short-term curative effect of roxadustat in the treatment of renal anemia in patients with peritoneal dialysis.Methods:70 patients with peritoneal dialysis renal anemia admitted to the dialysis department of our hospital from March 2021-March 2023 were selected as research objects,divided into a research group and a reference group according to random number drawing method,with each group consisting of 35 cases.The patients in the research group were treated with roxadustat,and those in the reference group were treated with recombinant human erythropoietin.The total efficacy,anemia index,iron metabolism index,and occurrence of adverse reactions were compared between the two groups.Results:The total efficacy of the treatment received in the research group was significantly higher than that in the reference group(P<0.05).In terms of anemia indicators,there was no statistically significant difference between the hemoglobin(Hb),the red blood cell(RBC),and the hematocrit(HCT)of both groups(P>0.05)before treatment.After treatment,the anemia indicators of the patients in the research group were significantly better than those in the reference group,(P<0.05).In terms of iron metabolism,before treatment,there was no significant difference between the total iron-binding capacity(TIBC),the transferrin(TRF),the ferritin(FER),and iron(Fe)of both groups(P>0.05).After treatment,the research group’s iron metabolism indicators were significantly better than those of the reference group(P<0.05).The incidence of adverse reactions in the research group was significantly lower than that in the reference group(P<0.05).Conclusion:The short-term curative effect of roxadustat in the treatment of peritoneal dialysis patients was demonstrated through this study,making it a viable treatment option.
文摘Adrenal hematoma is a rare condition with highly variable clinical manifestations, ranging from completely asymptomatic cases to specific signs. Abdominal ultrasound is the key examination for diagnosing and monitoring neonates. We present a case of adrenal hematoma diagnosed following neonatal anemia.
基金National Natural Science Foundation of China,No.81890992.
文摘BACKGROUND Congenital sideroblastic anemia(CSA)is a rare and heterogeneous group of genetic disorders.Conventional treatment include pyridoxine(vitamin B6)and allogeneic hematopoietic stem cell transplantation(allo-HSCT),and can alleviate anemia in the majority of cases.Nevertheless,some CSA cases remain unresponsive to pyridoxine or are unable to undergo allo-HSCT.Novel management approaches is necessary to be developed.To explore the response of luspatercept in treating congenital sideroblastic anemia.CASE SUMMARY We share our experience in luspatercept in a 4-year-old male patient with CSA.Luspatercept was administered subcutaneously at doses of 1.0 mg/kg/dose to 1.25 mg/kg/dose every 3 wk,three consecutive doses,evaluating the hematological response.Luspatercept leading to a significant improvement in the patient's anemia.The median hemoglobin during the overall treatment with three doses of luspatercept was 90(75-101)g/L,the median absolute reticulocyte count was 0.0593(0.0277-0.1030)×10^(12)/L,the median serum ferritin was 304.3(234.4-399)ng/mL,and the median lifespan of mature red blood cells was 80(57-92)days.Notably,no adverse reactions,such as headaches,dizziness,vomiting,joint pain,or back pain,were observed during the treatment period.CONCLUSION We believe that luspatercept might emerge as a viable therapeutic option for the maintenance treatment of CSA or as a bridging treatment option before hematopoietic stem cell transplantation.
文摘Renal anastomotic hemangioma(AH)is a rare,benign vascular tumor with unique histopathological features,a disease that is clinically rare,and existing clinical cases offer different treatment options.As reported in the text,this is a very unusual case of renal AH with AH secondary to residual renal tissue after renal clear cell carcinoma,describing a rare renal AH and a history of renal clear cell carcinoma,including ultrasound,computed tomography and magnetic re-sonance imaging.However,the available imaging data and the literature do not provide an effective basis for the diagnosis of the disease,raising the lack of un-derstanding and misdiagnosis,where the patient eventually underwent neph-rectomy,but the author is not the most appropriate surgical treatment.The po-stoperative pathological results of the patient are benign lesions,and it is unde-niable that nephrectomy is suspected to be overtreated.By reading the literature,we provide different insights into the treatment of the patient,and we hope that this paper can provide some help for the future clinical diagnosis and treatment.
文摘BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with significant long-term morbidity,and histological abnormalities such as crescentic glomerulonephritis are infrequently reported.PSAGN has also been linked to late-onset chronic kidney disease in some populations due to high levels of proteinuria.METHODS This prospective observational study was conducted at Lady Ridgeway Hospital(Colombo,Sri Lanka)over 15 months.Children with PSAGN were enrolled based on clinical and laboratory criteria.Persistent proteinuria≥2+for 2 weeks and serum creatinine>100μmol/L warranted renal biopsy,assessed via light microscopy and immunofluorescence.Normalization of complement 3(C3)within 6 to 8 weeks was required for inclusion.Data on clinical features,urine protein levels,and renal function were collected from patient records,and potential associations were analysed using Statistical Package for the Social Sciences and R language for statistical computing.Ethical approval was obtained from the Ethical Review Committee,Lady Ridgeway Hospital for Children(Ref No:LRH/ERC/2021/60).RESULTS Forty-four patients were recruited.There were 27(61.4%)male patients and 17(38.6%)female patients.Thirty-seven(84%)of them were above 5 years of age.Twenty(45%)patients had a history of skin sepsis,and eighteen(41%)had a history of throat infection.Among patients with proteinuria≥2+,53%had serum creatinine>100µmol/L,while among those with proteinuria<2+,7%had serum creatinine>100µmol/L.The association of high-degree proteinuria with elevated serum creatinine was significant(χ²=7.8,P=0.005)in PSAGN.The odds ratio of the logistic regression model was 1.049(95%confidence interval:1.003-1.098),indicating a positive direction with statistically significant association(P=0.037).There was no significant association between proteinuria and the degree of hypertension or estimated creatinine clearance.Ten children underwent renal biopsy.Crescents(less than 50%)were demonstrated in five children,while three children had typical diffuse proliferative glomer-ulonephritis.One child had severe acute tubular necrosis,and another had crescentic glomerulonephritis(crescents>50%).The immunofluorescence studies revealed deposition of immunoglobulin G and C3 in all biopsy specimens.CONCLUSION High-degree proteinuria was significantly associated with elevated serum creatinine(>100μmol/L)in children with PSAGN.The majority of children with persistent proteinuria≥2+for more than 2 weeks and the highest recorded serum creatinine>100μmol/L had atypical renal histological findings.
文摘Iron deficiency anemia(IDA)continues to be a global public health problem.Oral iron is the universally accepted first-line therapy,and most children have a prompt and favorable response to oral formulations.In subsets of children who fail to respond due to intolerance,poor adherence,or inadequate intestinal absorption,parenteral iron is indicated.Despite numerous studies in adults with IDA of diverse etiologies,pediatric studies on parenteral iron use are very limited.Although mostly retrospective and small,these studies have documented the efficacy and safety profile of intravenous iron formulations.In this editorial the author comments on the most important published data and underscores the need to seriously consider parenteral iron use in children unresponsive to oral therapy.
文摘BACKGROUND Exertional heat stroke(EHS)is a critical condition arising from prolonged physical exertion in high temperatures that typically presents with normal hemoglobin levels.However,atypical presentations can also occur,leading to significant complications such as hemolytic anemia and organ dysfunction.CASE SUMMARY This case report describes a male patient who experienced moderate-to-severe anemia that was difficult to correct,with a confirmed diagnosis of microangiopathic hemolytic anemia accompanying multiple organ dysfunction syndrome,indicative of critical EHS.Despite intensive resuscitation efforts,the patient’s condition deteriorated,necessitating admission to the intensive care unit for advanced management.CONCLUSION This case highlights the importance of recognizing atypical presentations of EHS,particularly that with significant hemolytic anemia and concurrent organ failure.Clinicians should maintain a high level of suspicion for these complications in patients displaying symptoms of heat-related illness,especially when caused by strenuous activity,as early diagnosis and intervention are crucial to improve patient outcomes.
文摘Alectinib is a selective Anaplastic Lymphoma Kinase (ALK) tyrosine kinase inhibitor used as standard therapy for ALK-rearranged lung adenocarcinoma. Hemolytic anemia is considered a rare but significant adverse event of alectinib. Here, we report the case of a 78-year-old female with advanced ALK rearrangement-positive lung adenocarcinoma who developed grade 4 drug-induced hemolytic anemia after receiving alectinib as first-line therapy. We discontinued alectinib treatment and switched to brigatinib. As a result, anemia improved without recurrence of lung adenocarcinoma over one year.
文摘Neonatal adrenal hemorrhage is frequently associated with birth trauma, perinatal asphyxia, intrauterine infection, coagulation defects and thromboembolism. It has varied clinical presentation depending on degree of hemorrhage and amount of adrenal cortex compromised by hemorrhage. The most common clinical presentations are persistent jaundice and flank mass. We report a case of left sided adrenal hemorrhage in a breech delivered male neonate with perinatal asphyxia presented with anemia and fever. On further evaluation, he was also having moderate communicating hydrocephalus secondary to intraventricular hemorrhage. The adrenal hemorrhage was managed conservatively. Subsequent abdominal ultrasound showed resolving adrenal hemorrhage. Right ventriculoperitoneal shunt was done for hydrocephalus. Postoperative course was uneventful. The patient is asymptomatic at follow-up.
文摘It was demonstrated pathologically that the histological structures of kidneys were impaired after subcutaneous injection of gentamycin for 16 consecutive days in rats. Laboratory parameters showed that serum blood urea nitrogen(BUN) and creatinine (Cr) elevated, while the indices of the erythrogenic line reduced markedly, and erythropoietin (EPO) was not detectable by ELISA. When the rats received recombinant human erythropoietin (rhEPO) for 5 d, the level of EPO in serum went up, and the indices of reticulocyte, red blood cell (RBC),hemoglobin (Hb) and hematocrit (Hct) improved rapidly, of which the response of reticulocyte was most sensitive. The results suggested that the erythrogenic function of the bone marrow in rats was enhanced after the stimulation of rhEPO, and the effect of rhEPO was dose dependent.
文摘Most anemia is related to the digestive system by dietary deficiency, malabsorption, or chronic bleeding. We review the World Health Organization definition of anemia, its morphological classifi cation (microcytic, macrocytic and normocytic) and pathogenic classi-fication (regenerative and hypo regenerative), and integration of these classifications. Interpretation of laboratory tests is included, from the simplest (blood count, routine biochemistry) to the more specific (iron metabolism, vitamin B12, folic acid, reticulocytes, erythropoietin, bone marrow examination and Schilling test). In the text and various algorithms, we propose a hierarchical and logical way to reach a diagnosis as quickly as possible, by properly managing the medical interview, physical examination, appropriate laboratory tests, bone marrow examination, and other comple-mentary tests. The prevalence is emphasized in all sections so that the gastroenterologist can direct the diagnosis to the most common diseases, although the tables also include rare diseases. Digestive diseases potentially causing anemia have been studied in preference, but other causes of anemia have been included in the text and tables. Primitive hematological diseases that cause anemia are only listed, but are not discussed in depth. The last section is dedicated to simplifying all items discussed above, using practical rules to guide diagnosis and medical care with the greatest economy of resources and time.