Central nervous system recurrence in a patient treated for acute promyelocytic leukemia,resulting in sideroblastic anemia:A case report

BACKGROUND Previous cases that have been stated in this article have displayed that around 1%to 7%of patients that have been treated with chemotherapy for acute promyelocytic leukemia developed myelodysplastic syndrome or acute myeloid leukemia.One can see that’s why this case presentation of a 60-year-old man that had a good response to acute promyelocytic leukemia treatment,that later presented with a central nervous system recurrence of acute promyelocytic leukemia and acquired sideroblastic anemia(a form of myelodysplasia)from treatment is a unique case report.CASE SUMMARY The presence of central nervous system relapse in acute promyelocytic leukemia patients is very unlikely compared to recurring mainly in the bone marrow.It is also uncommon to be diagnosed with sideroblastic anemia(form of myelodysplastic syndrome)as a result from treatment for acute promyelocytic leukemia.This case report highlights the detection,treatment/maintenance with idarubicin,all-trans-retinoic-acid,arsenic trioxide,methotrexate,6-mercaptopurine,and ommaya reservoir intrathecal methotrexate administration in a patient that had central nervous system relapse of acute promyelocytic leukemia and acquired sideroblastic anemia.CONCLUSION In essence,first time relapse concerning the central nervous system in treated acute promyelocytic leukemia patients who had a good response to therapy is very uncommon.The acquirement of a myelodysplastic syndrome such as ringed sideroblastic anemia is also rare regarding this patient population.Although such cases are infrequent,this case report represents a unique insight of the detection,treatment,and maintenance of a 60-year-old man diagnosed with acute promyelocytic leukemia,resulting in the acquirement of sideroblastic anemia and central nervous system relapse.

Parenteral iron therapy in children with iron deficiency anemia

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.

Prevalence of Anemia in Patients with Diabetes Mellitus:A Systematic Review and Meta-Analysis

Objective Anemia is a common public health concern in patients with type 2 diabetes worldwide.This study aimed to identify the prevalence of anemia among patients with diabetes.Methods Electronic databases,including PubMed,Scopus,Web of Sciences,and Google Scholar,were searched systematically for studies published between 2010 and 2021.After removing duplicates and inappropriate reports,the remaining manuscripts were reviewed and appraised using theNewcastleOttawa Scale(NOS)tool.A random-effects model was used to calculate the pooled estimates of the extracted data using Stata version 17.Heterogeneity of the studies was assessed using the Q statistic.Results A total of 51 articles containing information on 26,485 patients with diabetes were included in this study.The articles were mainly from Asia(58.82%)and Africa(35.29%).The overall prevalence of anemia was 35.45%(95%CI:30.30–40.76),with no evidence of heterogeneity by sex.Among the two continents with the highest number of studies,the prevalence of anemia in patients with diabetes was significantly higher in Asia[40.02;95%CI:32.72–47.54]compared to Africa[28.46;95%CI:21.90–35.50](P for heterogeneity=0.029).Moreover,there has been an increasing trend in the prevalence of anemia in patients with diabetes over time,from[15.28;95%CI:9.83–22.21]in 2012 to[40.70;95%CI:10.21–75.93]in 2022.Conclusion Globally,approximately 4 in 10 patients with diabetes suffer from anemia.Therefore,routine anemia screening and control programs every 3 months might be useful in improving the quality of life of these patients.

Sarcopenia and Anemia Are Predictors of Poor Prognostic in Cervical Cancer Patients

Objective: Evaluate pretreatment sarcopenia and anemia as prognostic factors in women undergoing treatment for cervical cancer (CC) with concurrent chemoradiotherapy (CCRT). Methods: 151 women with CC were analysed in this cohort study. Pretreatment computed tomography (CT) images were analysed to assess skeletal muscle index (SMI). Hazard ratios (HR) and multivariate Cox proportional HR were used to analyse association between low SMI, age, body mass index (BMI), haemoglobin levels, histological type, and International Federation of Gynaecology and Obstetrics (FIGO) stage with PFS and OS. Results: A total of 151 patients were included, 53 (35.1%) presented pretreatment sarcopenia;51 (34%) stage I/II and 100 (66%) stage III/IV. Among those patients in advanced stage (III/IV) 37 (70%) (p = 0.28) were sarcopenic at the beginning of treatment. Sarcopenia was associated with worse progression-free survival (PFS) and overall survival (OS) in our cohort [HR 0.97 (p = 0.01)] [HR 0.73 (p = 0.001)], as well as anemia [HR 0.73 (p = 0.001)] [HR 0.78 (p = 0.001)]. Linear regression models indicated that despite showing no association with age, neutrophil or platelet counts, sarcopenia was associated with pretreatment anemia levels (p = 0.01). After a multivariate analysis, only haemoglobin (anemia) and complete CCRT remained associated with PFS and OS. Sarcopenia and anemia were associated with worse PFS and OS in FIGO stage I/II. Conclusion: Pretreatment sarcopenia was significantly associated with low haemoglobin levels. Anemia and incomplete CCRT were independently associated with poor prognosis in women with CC. Pretreatment sarcopenia, as low SMI, was a predictor of poor prognostic in early stages of CC.

Prevalence and Factors Associated with Anemia among People Living with Human Immunodeficiency Virus Followed at the Outpatient Treatment Centre of Panzi General Referral Hospital in Eastern Democratic Republic of Congo

Introduction: Anemia in people living with human immunodeficiency virus (PLHIV) is a major health problem. Although anemia often responds to combination antiretroviral therapy, many patients remain anemic despite treatment, and such persistent anemia continues to adversely affect prognosis, regardless of drug response. Scientists have identified some of the factors involved. However, the mechanisms put in place have not been effective in overcoming them. Examples include the withdrawal of zidovudine from antiretroviral treatment lines, iron and folate supplementation, etc. Anemia is still a major concern in HIV-positive patients. The aim of this study is to assess the prevalence of anemia and its associated factors among PLHIV followed up at the outpatient treatment centre (CTA) of the Panzi General Reference Hospital (HGR) in South Kivu, Democratic Republic of Congo (DRC). Method: We conducted a cross-sectional, comparative study of 276 HIV-infected adults on antiretroviral therapy (ART) followed up at the CTA of Panzi HGR. Socio-demographic and nutritional parameters were collected using a survey questionnaire, and clinical assessment and nutritional status were performed at the centre. Hemoglobin, seric albumin and viral load determinations were performed at the HGRP laboratory. We constructed univariate and multivariate logistic regression models to assess factors associated with anemia in people living with HIV/AIDS. Results: We found a prevalence of anemia of 39.4%, including 4.1% severe anemia, 17.7% moderate anemia and 17.5% mild anemia. After multivariate adjustment, the factors associated with anemia in our PLHIV were: moderate undernutrition (aOR = 1.26;95% CI: 1.50 - 4.20;p = 0.001), severe undernutrition (aOR = 115.4;95% CI: 2.04 - 164.52;p = 0.021), hypoalbuminemia (aOR = 2.11;95% CI: 1.87 - 5.10;p = 0.004) and the lower degree of dietary diversity (aOR = 1.56;95% CI: 1.10 - 4.32;p = 0.034). Conclusion: The prevalence of anemia in PLHIV on ART is high. This greatly affects quality of life and increases the need for care. Early detection tools and management algorithms are essential in the follow-up of PLWHIV.

Efficacy and Safety of Iron Isomaltoside Compared with an Oral Iron Supplement in the Management of Patients with Iron Deficiency Anemia

Objective: To evaluate the treatment outcome of iron isomaltoside compared with an oral iron supplement in the management of iron deficiency anemia (IDA). Methods: The study included patients with IDA who visited the Outpatient Clinic of the Department of Hematology, the Affiliated Hospital of Qingdao University from October 2021 to August 2022 and met the inclusion and exclusion criteria. According to the actual application of iron supplementation, the patients were divided into two groups: iron isomaltoside treatment group and oral iron treatment group. Baseline measurements were collected before the start of treatment, and measurements were collected subsequently at intervals of 1 week, 1 month, and 3 months. The hematological parameters analyzed included Hemoglobin (Hb), Mean corpuscular hemoglobin (MCH), Mean Hemoglobin content (MCH), Mean corpuscular Hemoglobin concentration (MCHC), and Platelet (Plt). Safety data and adverse event profiles were recorded. Results: Intra-group comparisons: After 1 month of treatment, the Hb significantly improved (P 0.05). Inter-group comparisons: The biochemical parameters were significantly improved (P 0.05) in the iron isomaltoside group compared with those in the oral iron group after 1 month of iron supplementation in patients with mild and moderate anemia. Adverse reactions were tolerable for the patients in both iron isomaltoside group and oral iron group. Only 1 patient in iron isomaltoside group developed anaphylactic shock during medication and recovered after aggressive rescue. Conclusions: Iron isomaltoside which increases Hb more rapidly compared with the oral iron supplementation has few adverse reactions and good acceptance.

Growth differentiation factor-15 serum concentrations reflect disease severity and anemia in patients with inflammatory bowel disease

BACKGROUND Population of patients with inflammatory bowel disease(IBD)is burdened by various extraintestinal manifestations which substantially contribute to greater morbidity and mortality.Growth-differentiation factor-15(GDF-15)is often overexpressed under stress conditions,such as inflammation,malignancies,heart failure,myocardial ischemia,and many others.AIM To explore the association between GDF-15 and IBD as serum concentrations of GDF-15 were shown to be an independent predictor of poor outcomes in multiple diseases.An additional aim was to determine possible associations between GDF-15 and multiple clinical,anthropometric and laboratory parameters in patients with IBD.METHODS This cross-sectional study included 90 adult patients diagnosed with IBD,encompassing both Crohn’s disease(CD)and ulcerative colitis(UC),and 67 healthy age-and sex-matched controls.All patients underwent an extensive workup,including colonoscopy with subsequent histopathological analysis.Disease activity was assessed by two independent gastroenterology consultants specialized in IBD,employing well-established clinical and endoscopic scoring systems.GDF-15 serum concentrations were determined following an overnight fasting,using electrochemiluminescence immunoassay.RESULTS In patients with IBD,serum GDF-15 concentrations were significantly higher in comparison to the healthy controls[800(512-1154)pg/mL vs 412(407-424)pg/mL,P<0.001],whereas no difference in GDF-15 was found between patients with CD and UC[807(554-1451)pg/mL vs 790(509-956)pg/mL,P=0.324].Moreover,multiple linear regression analysis showed that GDF-15 levels predict CD and UC severity independent of age,sex,and C-reactive protein levels(P=0.016 and P=0.049,respectively).Finally,an association between GDF-15 and indices of anemia was established.Specifically,negative correlations were found between GDF-15 and serum iron levels(r=-0.248,P=0.021),as well as GDF-15 and hemoglobin(r=-0.351,P=0.021).Accordingly,in comparison to IBD patients with normal hemoglobin levels,GDF-15 serum levels were higher in patients with anemia(1256(502-2100)pg/mL vs 444(412-795)pg/mL,P<0.001).CONCLUSION For the first time,we demonstrated that serum concentrations of GDF-15 are elevated in patients with IBD in comparison to healthy controls,and the results imply that GDF-15 might be involved in IBD pathophysiology.Yet,it remains elusive whether GDF-15 could serve as a prognostic indicator in these patients.

Refractory autoimmune hemolytic anemia in a patient with systemic lupus erythematosus and ulcerative colitis:A case report

BACKGROUND Ulcerative colitis(UC)and systemic lupus erythematosus(SLE)are both systemic immunoreactive diseases,and their pathogenesis depends on the interaction between genes and environmental factors.There are no reports of UC with SLE in China,but six cases of SLE with UC have been reported in China.The combination of these two diseases has distinct effects on the pathogenesis of both diseases.CASE SUMMARY A female patient(30 years old)came to our hospital due to dull umbilical pain,diarrhea and mucous bloody stool in August 2018 and was diagnosed with UC.The symptoms were relieved after oral administration of mesalazine(1 g po tid)or folic acid(5 mg po qd),and the patient were fed a control diet.On June 24,2019,the patient was admitted for treatment due to anemia and tinnitus.During hospitalization,the patient had repeated low-grade fever and a progressively decreased Hb level.Blood tests revealed positive antinuclear antibody test,positive anti-dsDNA antibody,0.24 g/L C3(0.9-1.8 g/L),0.04 g/L C4(0.1-0.4 g/L),32.37 g/L immunoglobulin(8-17 g/L),and 31568.1 mg/24 h total 24-h urine protein(0-150 mg/24 h).The patient was diagnosed with SLE involving the joints,kidneys and blood system.Previously reported cases of SLE were retrieved from PubMed to characterize clinicopathological features and identify prognostic factors for SLE.CONCLUSION The patient was discharged in remission after a series of treatments,such as intravenous methylprednisolone sodium succinate,intravenous human immunoglobulin,cyclophosphamide injection,and plasma exchange.After discharge,the patient took oral prednisone acetate tablets,cyclosporine capsules,hydroxychloroquine sulfate tablets and other treatments for symptoms and was followed up regularly for 1 month,after which the patient's condition continued to improve and stabilize.

Effect of ginsenoside Rg1 on hematopoietic stem cells in treating aplastic anemia in mice via MAPK pathway

BACKGROUND Aplastic anemia(AA)presents a significant clinical challenge as a life-threatening condition due to failure to produce essential blood cells,with the current the-rapeutic options being notably limited.AIM To assess the therapeutic potential of ginsenoside Rg1 on AA,specifically its protective effects,while elucidating the mechanism at play.METHODS We employed a model of myelosuppression induced by cyclophosphamide(CTX)in C57 mice,followed by administration of ginsenoside Rg1 over 13 d.The invest-igation included examining the bone marrow,thymus and spleen for pathological changes via hematoxylin-eosin staining.Moreover,orbital blood of mice was collected for blood routine examinations.Flow cytometry was employed to identify the impact of ginsenoside Rg1 on cell apoptosis and cycle in the bone marrow of AA mice.Additionally,the study further evaluated cytokine levels with enzyme-linked immunosorbent assay and analyzed the expression of key proteins in the MAPK signaling pathway via western blot.RESULTS Administration of CTX led to significant damage to the bone marrow’s structural integrity and a reduction in hematopoietic cells,establishing a model of AA.Ginsenoside Rg1 successfully reversed hematopoietic dysfunction in AA mice.In comparison to the AA group,ginsenoside Rg1 provided relief by reducing the induction of cell apoptosis and inflammation factors caused by CTX.Furthermore,it helped alleviate the blockade in the cell cycle.Treatment with ginsenoside Rg1 significantly alleviated myelosuppression in mice by inhibiting the MAPK signaling pathway.CONCLUSION This study suggested that ginsenoside Rg1 addresses AA by alleviating myelosuppression,primarily through modulating the MAPK signaling pathway,which paves the way for a novel therapeutic strategy in treating AA,highlighting the potential of ginsenoside Rg1 as a beneficial intervention.

Intermittent melena and refractory anemia due to jejunal cavernous lymphangioma:A case report

BACKGROUND Lymphangiomas in the gastrointestinal tract are extremely rare in adults.As a benign lesion,small intestine lymphangiomas often remain asymptomatic and pose challenges for definitive diagnosis.However,lymphangiomas can give rise to complications such as abdominal pain,bleeding,volvulus,and intussusception.Here,we report a case of jejunal cavernous lymphangioma that presented with intermittent melena and refractory anemia in a male adult.CASE SUMMARY A 66-year-old man presented with intermittent melena,fatigue and refractory anemia nine months prior.Esophagogastroduodenoscopy and colonoscopy were performed many times and revealed no apparent bleeding.Conservative management,including transfusion,hemostasis,gastric acid secretion inhibition and symptomatic treatment,was performed,but the lesions tended to recur shortly after surgery.Ultimately,the patient underwent capsule endoscopy,which revealed a more than 10 cm lesion accompanied by active bleeding.After singleballoon enteroscopy and biopsy,a diagnosis of jejunal cavernous lymphangioma was confirmed,and the patient underwent surgical resection.No complications or recurrences were observed postoperatively.CONCLUSION Jejunal cavernous lymphangioma should be considered a cause of obscure gastrointestinal bleeding.Capsule endoscopy and single-balloon enteroscopy can facilitate diagnosis.Surgical resection is an effective management method.

Inpatient management of iron deficiency anemia in pediatric patients with inflammatory bowel disease: A single center experience

BACKGROUND Screening for iron deficiency anemia(IDA)is important in managing pediatric patients with inflammatory bowel disease(IBD).Concerns related to adverse reactions may contribute to a reluctance to prescribe intravenous(IV)iron to treat IDA in this population.AIM To track the efficacy and safety of IV iron therapy in treating IDA in pediatric IBD patients admitted to our center.METHODS A longitudinal observational cohort study was performed on 236 consecutive pediatric patients admitted to our tertiary IBD care center between September 2017 and December 2019.92 patients met study criteria for IDA,of which 57 received IV iron,17 received oral iron,and 18 were discharged prior to receiving iron therapy.RESULTS Patients treated with IV iron during their hospitalization experienced a significant increase of 1.9(±0.2)g/dL in mean(±SE)hemoglobin(Hb)concentration by the first ambulatory follow-up,compared to patients who received oral iron 0.8(±0.3)g/dL or no iron 0.8(±0.3)g/dL(P=0.03).One out of 57(1.8%)patients that received IV iron therapy experienced an adverse reaction.CONCLUSION Our findings demonstrate that treatment with IV iron therapy is safe and efficacious in improving Hb and iron levels in pediatric patients with IDA and active IBD.

A Cross-Sectional Study on The Prevalence of Anemia in Maintenance Hemodialysis and Peritoneal Dialysis Patients and Its Related Factors

Objective:To study the prevalence of anemia,the proportion of hemoglobin(Hb)levels,the treatment methods,and the influencing factors of Hb levels in maintenance hemodialysis(MHD)and peritoneal dialysis patients.Methods:In this study,602 patients with maintenance hemodialysis and continuous ambulatory peritoneal dialysis were enrolled from December 2020 to December 2022 in our hospital,and their medical records were collected and summarized.The main contents included the patient’s gender,age,primary disease,dialysis duration,dialysis method,the use of erythropoietic stimulating agents(ESA),intravenous iron,and laboratory tests.A Hb index exceeding 110 g/L was set as the standard for the prevalence of anemia.Results:The rate of anemia in patients undergoing blood purification was 83%.The proportion of ESA use was 84.1%,and the proportion of iron use was 76.7%,of which the proportion of intravenous iron used was 17.0%,and the proportion of folic acid used was 28.3%.Conclusion:The incidence of anemia in MHD patients was relatively high,with a low proportion of patients reaching the standard Hb levels.Risk factors include albumin(ALB)levels,iron storage,white blood cells,C-reactive protein,cholesterol,etc.Nutritional support,iron supplementation,and prevention of micro-inflammatory reactions can effectively promote the improvement of Hb indicators in dialysis patients to prevent anemia.

Anemia status of infants and young children aged six to thirty-six months in Ma'anshan City:A retrospective study

BACKGROUND Anemia in infants and young children can have long-term effects on cognitive and physical development.In Ma'anshan City,China,there has been growing concern about the prevalence of anemia among children aged 6 to 36 mo.Understanding the factors influencing this condition is crucial for targeted interventions and improving overall child health in the region.AIM To analyze the anemia status and influencing factors of infants and young children aged 6 to 36 mo in Ma'anshan City,China.Providing scientific evidence for reducing the incidence of anemia and improving the health level of children in this age group.METHODS The study encompassed 37698 infants and young children,aged from 6 to 36 mo,who underwent health examinations at the Ma'anshan Maternal and Child Health Hospital from January 2018 to October 2022 were included in the study.Basic information,physical examination,and hemoglobin detection data were collected.Descriptive analysis was used to analyze the prevalence of anemia in children in the region,and univariate analysis was used to analyze the influencing factors of anemia.RESULTS The mean hemoglobin level of infants and young children aged 9 to 36 mo increased with age,and the anemia detection rate decreased with age.The anemia detection rate in rural infants aged 6,9,and 12 mo was higher than that in urban infants.Although the anemia detection rate was higher in 6-mo-old boys than girls,it was higher in 24-mo-old girls than boys.There were statistically significant differences in the anemia detection rates among 9-mo-old and 12-mo-old infants with different nutritional statuses(emaciation,overweight,obese,and normal).Moreover,there were no statistically significant differences in anemia detection rates among infants and young children with different nutritional statuses at other ages.Besides,the anemia detection rates in obese infants aged 9 and 12 mo were higher than those in normal and overweight infants,with statistically significant differences.Finally,there were no statistically significant differences in the anemia detection rates between emaciation infants and those with other nutritional statuses.CONCLUSION The anemia situation among infants and young children aged 6 to 36 mo in Ma'anshan City,China,is relatively prominent and influenced by various factors.Our result shown that attention should be paid to the anemic infant and young child population,with strengthened education and targeted prevention and dietary guidance to help them establish good living habits,improve nutritional status,and reduce the occurrence of anemia to improve children's health levels.

Ferric carboxymaltose for anemia in Crohn’s disease patients at a tertiary center:A retrospective observational cohort study

BACKGROUND Although the gastrointestinal tract is the most affected by Crohn’s disease(CD),the condition triggers other consequent manifestations,and iron deficiency anemia(IDA)is one of the most common.Intravenous(IV)iron replacement is currently available through several drugs,such as ferric hydroxide sucrose and ferric carboxymaltose(FCM).However,the clinical management of these conditions can be challenging.AIM To elucidate the drug’s effectiveness,the present study analyzed,through medical records,the clinical and epidemiological data of a cohort of patients with active CD who received IV FCM for the IDA treatment.METHODS This retrospective observational study included 25 patients with active CD,severe anemia,and refractory to previous conventional treatments.Patients were evaluated two times:During the last treatment with ferric hydroxide sucrose and treatment with FCM.RESULTS After treatment with FCM,parameters of IDA assessment significantly improved,serum hemoglobin(Hb)levels increased in 93%of patients(P<0.0001),and in 44%,there was an increase of≥2 g/dL in a single application.In addition,86%of the patients showed an increase in serum iron(P<0.0001)and ferritin(P=0.0008)and 50%in transferrin saturation(P=0.01).The serum iron levels at baseline showed a negative association with the ileal and colonic CD and use of biologics and a positive association with patients who developed CD later in life after the age of 40(A3)and with a stenosing(B2)and fistulizing(B3)phenotype.The values of Hb and hematocrit after ferric hydroxide sucrose treatment remained similar to those found before treatment.CONCLUSION This study demonstrated that FCM is an important therapeutic strategy for treating IDA in CD patients,achieving satisfactory results in refractory cases.

Nomogram based on clinical characteristics for predicting overall survival in gastric cancer patients with preoperative anemia

BACKGROUND Preoperative anemia is associated with increased postoperative morbidity and mortality and increased perioperative transfusion risk.For surgical patients,this affects physical and cognitive ability and quality of life,but it is an important and modifiable risk factor.AIM To determine the effect of preoperative anemia on the prognosis of gastric cancer(GC)patients and generate a prognostic nomogram to predict the postoperative overall survival(OS)of GC patients with preoperative anemia.METHODS Clinicopathological and follow-up data of GC patients treated at Zhejiang Provincial People's Hospital(China)from 2010 to 2015 were collected.Independent prognostic factors were screened by univariate and multivariate Cox regression analyses.Then,these factors were used to construct a nomogram to predict 1-,3-,and 5-year postoperative OS in preoperative anemic GC patients.The nomogram was assessed by calibration curves,receiver operating characteristic(ROC)curves,and decision curve analysis(DCA).RESULTS Nine hundred and sixty GC patients were divided into two groups(preoper atively anemic and nonanemic),and postoperative survival analysis was performed on both groups,yielding a shorter postoperative survival for preoperatively anemic patients than for nonanemic patients.A total of 347 GC patients with preoperative anemia were included.Age,preoperative alpha-fetoprotein level,monocyte count,lymphocyte count,clinicopathological stage,liver metastasis,and GC type were identified as independent prognostic factors for OS.The area under the ROC curve(AUC)of the nomogram for predicting 1-,3-,and 5-year OS was 0.831,0.845,and 0.840,respectively,for the training cohort,and the corresponding AUC values in the validation cohort were 0.827,0.829,and 0.812,respectively.Calibration curves and DCA indicated good performance of the nomogram.CONCLUSION In all,we have successfully produced and verified a useful nomogram for predicting OS in GC patients with preoperative anemia.This nomogram based on a variety of clinicopathological indices can provide an effective prognostic assessment and help clinicians choose an appropriate treatment strategy for GC patients with preoperative anemia.

Anemia in cirrhosis:An underestimated entity

Anemia in a patient with cirrhosis is a clinically pertinent but often overlooked clinical entity.Relevant guidelines highlight the algorithmic approach of managing a patient of cirrhosis presenting with acute variceal hemorrhage but day-to-day management in hospital and out-patient raises multiple dilemmas:Whether anemia is a disease complication or a part of the disease spectrum?Should iron,folic acid,and vitamin B complex supplementation and nutritional advice,suffice in those who can perform tasks of daily living but have persistently low hemoglobin.How does one investigate and manage anemia due to multifactorial etiologies in the same patient:Acute or chronic blood loss because of portal hypertension and bone marrow aplasia secondary to hepatitis B or C viremia?To add to the clinician’s woes the prevalence of anemia increases with increasing disease severity.We thus aim to critically analyze the various pathophysiological mechanisms complicating anemia in a patient with cirrhosis with an emphasis on the diagnostic flowchart in such patients and proposed management protocols thereafter.

Particularities of Anemia in the Elderly: Experience in a Geriatrics Department in Senegal

Background/Objective: Anemias are frequent conditions in geriatric practice. The etiologies are numerous, overlapping chronic and acute pathologies. it is also associated with high morbidity and mortality. In our context, few studies have addressed this issue, and none have been carried out in geriatric units with integrated geriatric dimensions. The aim of this study was to describe the particularities of anemia in old people in a geriatric short-stay service in Senegal. Materials and methods: This was a retrospective, descriptive study from 01 May 2019 to 31 December 2021, involving people aged 60 or over, hospitalized in the geriatrics department of Fann Hospital (Senegal) and presenting with anemia. Epidemiological, clinical and evolutionary characteristics were collected and analyzed using SPSS 24.0 software. Results: The prevalence of anemia was 32.3%. The mean age of our sample was 78.7 ± 8.5 years. Arterial high blood pressure (59.3%), diabetes mellitus (22.8%), prostate disease (12.3%) were the most frequent comorbidities. Clinical manifestations were dominated by physical asthenia (80%) and severe alteration of general condition (72%). The geriatric syndromes were essentially represented by the loss of Activities Daily Living (ADL) autonomy (65%), undernutrition (59%) and frailty (46%). The mean hemoglobin level was 8.4 g/dl ± 2.1. The main etiologies were infections (32.7%), chronic kidney disease (20.9%), iron deficiency (7.4%). The mean hospital stay was 8 days ± 3.7 days and the mortality rate was 19%. Conclusion: Anemia is a frequent occurrence in geriatric medicine, with a high morbidity and mortality rate;its expression is often atypical, with frequent geriatric syndromes;the etiologies are multiple and often interrelated, requiring an exhaustive and multidimensional approach.

Aqueous Leaf Extract of Moringa oleifera (Moringaceae) Effectively Treats Induced Hemolytic Anemia in Wistar Rats

Introduction: Moringa oleifera was a medicinal plant generally used by populations in the food and therapeutic fields. It’s used to treat anemia has been observed in the Djougou Zone in northern Benin. To our knowledge, there were no scientific data available that have evaluated its efficacy in the treatment of haemolytic anemia. This was what justifies this research work in which the phytochemical analysis, extraction and evaluation of the anti-anemic effect were carried out. Methods: Five groups of five Wistar rats each were formed. All the rats were rendered anemic by injection of phenylhydrazine hydrochloride on the first two days D0 and D1 except those in the negative control group. From the second day, the anemic groups were force-fed either with the aqueous extract of Moringa oleifera leaves at 200 or 300 mg/kg body weight/day, or with vitafer, the reference drug against anemia. The positive control group (anemia) was not treated. Blood samples were taken from all the rats on different days: D0, D2, D7, D10 and D15 to evaluate the data of the hemogram and the osmotic resistance of the red blood cells. Results: Phytochemical analysis revealed the presence of tannins, flavonoids, leucoanthocyanins, saponosides, triterpenes and mucilages. A good yield was obtained at the extraction. Both the extract and the reference drug vitafer completely corrected anemia within two weeks after stimulating hemoglobin synthesis and early release of immature red blood cells into the bloodstream. Its effect seemed dose-dependent and specific. Conclusion: Moringa oleifera leaves showed good therapeutic efficacy and can be considered and exploited for transformation into improved traditional medicines (ITM) in the treatment of anemia.

Iron versus Iron and Vitamin B6 Supplementation in Treatment of Iron Deficiency Anemia during Second Trimester of Pregnancy: Quasi Experimental Trial

Background: Anemia is one of the most prevalent complications during pregnancy. It is commonly considered a risk factor for poor pregnancy outcomes and can result in complications that threaten the life of both mother and fetus, such as preterm birth, and low birth weight. There is clear evidence to support prompt treatment in all patients with iron deficiency anemia because it is known that treatment improves quality of life and physical condition as well as alleviates fatigue and cognitive deficits. Objective: The aim of the study was to evaluate the value of addition of vitamin B6 to iron in treatment of iron deficiency anemia in pregnant women during the second trimester. Patients and Methods: The study was done by giving anemia pregnant women iron therapy and vitamin B6 which represent group A and iron therapy alone which represents group B. For each pregnant woman, age, parity and gestational history were taken before treatment. All pregnant women took their allocated treatment regularly for three weeks after diagnosis of iron deficiency anemia with complete blood picture and followed up after three weeks. Results: Results of the study revealed that there was no statistically significant difference between the two groups of therapy according to the hemoglobin level before treatment (p-value = 0.734), statistically significant higher mean value in after treatment than before treatment (p-value = 0.048), there was a significant difference in the rate of change of hemoglobin (p-value = 0.011) and body mass index (p-value 0.001). Conclusion: Iron and vitamin B6 seems to increase hemoglobin level more than iron only. Thus, in pregnant women with iron deficiency anemia iron plus vitamin B6 may be considered as a more effective alternative treatment than iron only.

Aetiologic Factors of Anemia During Heart Failure in Brazzaville (The Republic of the Congo)

To contribute to improving the management of patients with heart failure and anemia in Brazzaville, a prospective and descriptive study was conducted in the University Hospital of Brazzaville for nine months (January 1st to September 30, 2017). Included 57 patients hospitalized for left or global heart failure and presenting anemia. Anemia was defined by an haemoglobin level < 12 g/dL in men and <11 g/dL in women. Proportionings of the reticulocytes rate, serum iron, ferritin, erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP), electrophoresis of proteins, and evaluation of renal function by glomerular filtration rate (GFR), as well as the treatments of heart failure, and the auxiliary therapeutic ones, in particular the antithrombotic drugs, allowed aetiologic research. They were 20 men (35%) and 37 women (65%), old on average of 59 ± 17 years. The average rate of haemoglobin was 11.4 ± 1.4 g/dL. Heart failure was de novo in 24 cases (42.1%), old in 33 cases (57.9%);it was global in 54 cases (94.7%).The maintenance treatment associated diuretics in 32 cases (97%), angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in 31 cases (94%), beta-blockers in two cases (6.1%), digoxin in four cases (12.1%), aspirin in five cases (15.1%) and anti-vitamin K in four cases (12.1%). Anemia was microcytic hypochromic in 30 cases (52.6%), normocytic normochromic in 20 cases (35.1%), and macrocytic normochromic in one case (1.7%). The main aetiologic factors were hemodilution in 46 cases (80.7%), renal insufficiency in 30 cases (52.3%), inflammation in 29 cases (50.8%), and iron deficiency in one case (1.7%). The HIV serology, carried out in 11 cases, was negative. Anemia is a frequent comorbidity among heart failure patients. Aetiologic research remains difficult in our context, and its often multifactorial origin.