血常规检验在鉴别诊断地中海贫血、缺铁性贫血中的临床意义

分析诊断地中海贫血、缺铁性贫血时采取血常规检验的意义。方法 选取200例贫血患者,根据患者贫血类型分A、B组,各100例;并选取同期健康体检者为对照组。实施血常规检验,对比鉴定结果。结果 将检测,贫血组患者与对照组血常规指标差异显著(P<0.05),A组Hb、MCH、MCHC高于B组,RBC、RDW、MCV低于B组(P<0.05)。结论 血常规检验能够及时筛选出贫血患者,同时还可为对地中海贫血、缺铁性贫血的鉴别诊断提供重要参考信息,且操作快捷、方便,对操作技术要求不高,能够在基层医院推广。

渝南地区成人缺铁性贫血患者社会因素的调查分析

目的了解渝南地区成人缺铁性贫血(IDA)患者与社会因素的相关性。方法选择渝南地区4所大型医院为调查点,开展问卷调查,进行logistic回归分析社会因素对成人缺铁性贫血的影响。结果分析显示,长期吸烟相对不吸及偶尔吸烟OR=0.654,膳食合理相对膳食不合理OR=2.435,中学和大学文化程度相对小学及以下文化程度OR=0.164、0.096,家庭人数4人及以上相对3人及以下OR=0.424、0.118,工作紧张相对工作宽松OR=0.368,工作时间固定相对工作时间不固定OR=2.700,上述比较差异有统计学意义(P<0.05)。结论吸烟、紧张工作和无固定工作时间是缺铁性贫血的独立危险因素,而合理膳食、较高文化程度和3人及以上家庭规模是独立保护因素。

A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases

Iron deficiency （ID）, with or without anemia, is often caused by digestive diseases and should always be investigated, except in very specific situations, as its causes could be serious diseases, such as cancer. Diagnosis of ID is not always easy. Low serum levels of ferritin or transferrin saturation, imply a situation of absolute or functional ID. It is sometimes difficult to differentiate ID anemia from anemia of chronic diseases, which can coexist. In this case, other parameters, such as soluble transferrin receptor activity can be very useful. After an initial evaluation by clinical history, urine analysis, and serological tests for celiac disease, gastroscopy and colonoscopy are the key diagnostic tools for investigating the origin of ID, and will detect the most important and prevalent diseases. If both tests are normal and anemia is not severe, treatment with oral iron can be indicated, along with stopping any treatment with non-steroidal anti-inflammatory drugs. In the absence of response to oral iron, or if the anemia is severe or clinical suspicion of important disease persists, we must insist on diagnostic evaluation. Repeat endoscopic studies should be considered in many cases and if both still show normal results, investigating the small bowel must be considered. The main techniques in this case are capsule endoscopy, followed by

A new iron free treatment with oral fish cartilage polysaccharide for iron deficiency chronic anemia in inflammatory bowel diseases:A pilot study

AIM： To investigate the effect of a new oral preparation, highly concentrated in fish cartilage, in a group of inflammatory bowel diseases （IBD） patients with chronic iron deficient anemia. METHODS： In an open label pilot study, we supplemented a group of 25 patients （11 with Crohn＇s disease and 14 with ulcerative colitis） in stable clinical conditions and chronic anemia with a food supplement which does not contain iron but contains a standardized fraction of fish cartilage glycosaminoglycans and a mixture of antioxidants （Captafer Medestea, Turin, Italy）. Patients received 500 mg, twice a day during meals, for at least 4 mo. Patients were suggested to maintain their alimentary habit. At time 0 and after 2 and 4 too, emocrome, sideremia and ferritin were examined. Paired data were analyzed with Student＇s t test. RESULTS： Three patients relapsed during the study （2 in the 3^rd too, 1 in the 4^th too）, two patients were lost to follow up and two patients dropped out （1 for orticaria, 1 for gastric burning）. Of the remaining 18 patients, levels of serum iron started to rapidly increase within the 2^nd mo of treatment, P 〈 0.05）, whereas serum ferritin and hemoglobin needed a longer period to significantly improve their serum levels （too 4） P 〈 0.05. The product was safe, easy to administer and well tolerated by patients. CONCLUSION： These data suggest a potential new treatment for IBD patients with iron deficiency chronic anemia and warrant further larger controlled studies.

Anemia after gastrectomy for early gastric cancer:Long-term follow-up observational study

AIM:To identify the incidence and etiology of anemia after gastrectomy in patients with long-term follow-up after gastrectomy for early gastric cancer.METHODS:The medical records of those patients with early gastric adenocarcinoma who underwent curative gastrectomy between January 2006 and October 2007 were reviewed.Patients with anemia in the preoperative workup,cancer recurrence,undergoing systemic chemotherapy,with other medical conditions that can cause anemia,or treated during follow up with red cell transfusions or supplements for anemia were excluded.Anemia was defined by World Health Organization criteria(Hb < 12 g/dL in women and < 13 g/dL in men).Iron deficiency was defined as serum ferritin < 20 g/dL.Vitamin B12 deficiency was defined as serum vitamin B 12 < 200 pg/mL.Iron deficiency anemia was defined as anemia with concomitant iron deficiency.Anemia from vitamin B 12 deficiency was defined as megaloblastic anemia(mean cell volume > 100 fL) with vitamin B 12 deficiency.The profile of anemia over 48 mo of follow-up was analyzed.RESULTS:One hundred sixty-one patients with gastrectomy for early gastric cancer were analyzed.The incidence of anemia was 24.5% at 3 mo after surgery and increased up to 37.1% at 48 mo after surgery.The incidence of iron deficiency anemia increased during the follow up and became the major cause of anemia at 48 mo after surgery.Anemia of chronic disease and megaloblastic anemia were uncommon.The incidence of anemia in female patients was significantly higher than in male patients at 12(40.0% vs 22.0%,P = 0.033),24(45.0% vs 25.0%,P = 0.023),36(55.0% vs 28.0%,P = 0.004),and 48 mo(52.0% vs 31.0%,P = 0.022) after surgery.Patients with total gastrectomy showed significantly higher incidence of anemia than patients with subtotal gastrectomy at 48 mo after surgery(60.7% vs 31.3%,P = 0.008).The incidence of iron deficiency was significantly higher in female patients than in male patients at 6(35.4% vs 13.3%,P = 0.002),12(45.8% vs 16.8%,P < 0.001),18(52.1% vs 22.3%,P < 0.001),24(60.4% vs 20.9%,P < 0.001),36(62.5% vs 29.2%,P < 0.001),and 48 mo(66.7% vs 34.7%,P = 0.001) after surgery.CONCLUSION:Anemia was frequent after gastrectomy for early gastric cancer,with iron deficiency being the major cause.Evaluation for anemia including iron status should be performed after gastrectomy and appropriate iron replacement should be considered.

Large pedinculated antral hyperplastic gastric polyp traversed the bulbus causing outlet obstruction and iron deficiency anemia: endoscopic removal

We present here a large (3 cm) hyperplastic gastric polyp prolapsed into duodenum and caused outlet obstruction and iron deficiency anemia in 60 years old male patient.Endoscopic removal was performed successfully.

Endoscopic management of chronic radiation proctitis

Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously,some lead to chronic symptoms including diarrhea,tenesmus,urgency and persistent rectal bleeding with iron deficiency anemia requiring blood transfusions. Treatments for chronic radiation proctitis remain unsatisfactory and the basis of evidence for various therapies is generally insuff icient. There are very few controlled or prospective trials,and comparisons between therapies are limited because of different evaluation methods. Medical treatments,including formalin,topical sucralfate,5-amino salicylic acid enemas,and short chain fatty acids have been used with limited success.Surgical management is associated with high morbidity and mortality. Endoscopic therapy using modalities such as the heater probe,neodymium:yttrium-aluminium-garnet laser,potassium titanyl phosphate laser and bipolar electrocoagulation has been reported to be of some benef it,but with frequent complications.Argon plasma coagulation is touted to be the preferred endoscopic therapy due to its eff icacy and safety profile.Newer methods of endoscopic ablation such as radiofrequency ablation and cryotherapy have been recently described which may afford broader areas of treatment per application,with lower rate of complications.This review will focus on endoscopic ablation therapies,including such newer modalities,for chronic radiation proctitis.

An update on iron physiology

Iron is an essential micronutrient, as it is required for adequate erythropoietic function, oxidative metabolism and cellular immune responses. Although the absorption of dietary iron (1-2 mg/d) is regulated tightly, it is just balanced with losses. Therefore, internal turnover of iron is essential to meet the requirements for erythropoiesis (20-30 mg/d). Increased iron requirements, limited external supply, and increased blood loss may lead to iron deficiency (ID) and iron-deficiency anemia. Hepcidin, which is made primarily in hepatocytes in response to liver iron levels, inflammation, hypoxia and anemia, is the main iron regulatory hormone. Once secreted into the circulation, hepcidin binds ferroportin on enterocytes and macrophages, which triggers its internalization and lysosomal degradation. Thus, in chronic inflammation, the excess of hepcidin decreases iron absorption and prevents iron recycling, which results in hypoferremia and iron-restricted erythropoiesis, despite normal iron stores (functional ID), and anemia of chronic disease (ACD), which can evolve to ACD plus true ID (ACD + ID). In contrast, low hepcidin expression may lead to iron overload, and vice versa. Laboratory tests provide evidence of iron depletion in the body, or reflect iron-deficient red cell production. The appropriate combination of these laboratory tests help to establish a correct diagnosis of ID status and anemia.

A short review of malabsorption and anemia

Anemia is a frequent finding in most diseases which cause malabsorption. The most frequent etiology is the combination of iron and vitamin B12 deficiency. Celiac disease is frequently diagnosed in patients referred for evaluation of iron deficiency anemia (IDA), being reported in 1.8%-14.6% of patients. Therefore, duodenal biopsies should be taken during endoscopy if no obvious cause of iron defi ciency (ID) can be found. Cobalamin defi ciency occurs frequently among elderly patients, but it is often unrecognized because the clinical manifestations are subtle; it is caused primarily by food-cobalamin malabsorption and pernicious anemia. The classic treatment of cobalamin deficiency has been parenteral administration of the vitamin. Recent data suggest that alternative routes of cobalamin administration (oral and nasal) may be useful in some cases. Anemia is a frequent complication of gastrectomy, and has been often described after bariatric surgery. It has been shown that banding procedures which maintain digestive continuity with the antrum and duodenum are associated with low rates of ID. Helicobacter pylori (H pylori) infection may be considered as a risk factor for IDA, mainly in groups with high demands for iron, such as some children and adolescents. Further controlled trials are needed before making solid recommendations about H pylori eradication in these cases.

Distribution of bleeding gastrointestinal angioectasias in a Western population

AIM:To define which segments of the gastrointestinal tract are most likely to yield angioectasias for ablative therapy. METHODS:A retrospective chart review was performed for patients treated in the Louisiana State University Health Sciences Center Gastroenterology clinics between the dates of July 1, 2007 and October 1, 2010. The selection of cases for review was initiated by use of our electronic medical record to identify all patients with a diagnosis of angioectasia, angiodysplasia, or arteriovenous malformation. Of these cases, chart reviews identified patients who had a complete evaluation of their gastrointestinal tract as defined by at least one upper endoscopy, colonoscopy and small bowel capsule endoscopy within the past three years. Patients without evidence of overt gastrointestinal bleeding or iron deficiency anemia associated with intestinal angioectasias were classified as asymptomatic and excluded from this analysis. Thirty-five patients with confirmed, bleeding intestinal angioectasias who had undergone complete endoscopic evaluation of the gastrointestinal tract were included in the final analysis. RESULTS:A total of 127 cases were reviewed. Sixtysix were excluded during subsequent screening due to lack of complete small bowel evaluation and/or lack of documentation of overt bleeding or iron deficiency anemia. The 61 remaining cases were carefully examined with independent review of endoscopic images as well as complete capsule endoscopy videos. This anal- ysis excluded 26 additional cases due to insufficient records/images for review, incomplete capsule examination, poor capsule visualization or lack of confirmation of typical angioectasias by the principal investigator on independent review. Thirty-five cases met criteria for final analysis. All study patients were age 50 years or older and 13 patients (37.1%) had chronic kidney disease stage 3 or higher. Twenty of 35 patients were taking aspirin (81 mg or 325 mg), clopidogrel, and/or warfarin, with 8/20 on combination therapy. The number and location of angioectasis was documented for each case. Lesions were then classified into the following segments of the gastrointestinal tract:esophagus, stomach, duodenum, jejunum, ileum, right colon and left colon. The location of lesions within the small bowel observed by capsule endoscopy was generally defined by percentage of total small bowel transit time with times of 0%-9%, 10%-39%, and 40%-100% corresponding to the duodenum, jejunum and ileum, respectively. Independent review of complete capsule studies allowed for deviation from this guideline if capsule passage was delayed in one or more segments. In addition, the location and number of angioectasias observed in the small bowel was further modified or confirmed by subsequent device-assisted enteroscopy (DAE) performed in the 83% of cases. In our study population, angioectasias were most commonly found in the jejunum (80%) followed by the duodenum (51%), stomach (22.8%), and right colon (11.4%). Only two patients were found to have angioectasias in the ileum (5.7%). Twenty-one patients (60%) had angioectasias in more than one location.CONCLUSION:Patients being considered for endoscopic ablation of symptomatic angioectasias should undergo push enteroscopy or anterograde DAE and reinspection of the right colon.

Hypergastrinemia and recurrent type 1 gastric carcinoid in a young Indian male: Necessity for antrectomy?

Carcinoid tumors are the most common neuroendocrine tumors. Gastric carcinoids represent 2% of all carcinoids and 1% of all gastric masses. Due to the wide-spread use of Esophagogastroduodenoscopy for evaluating a variety of upper gastrointestinal symptoms, the detection of early gastric carcinoids has increased. We highlight an alternative management of a young patient with recurrent type 1 gastric carcinoids with greater than 5 lesions, as well as lesions intermittently greater than 1 cm. Gastric carcinoids have a variable presentation and clinical course that is highly dependent on type. Type 1 gastric carcinoids are usually indolent and have a metastasis rate of less than 2%, even with tumors larger than 2 cm. There are a number of experts as well as organizations that recommend endoscopic resection for all type 1 gastric carcinoid lesions less than 1 cm, with a follow-up every 6-12 mo. They also recommend antrectomy for type 1 gastric carcinoids with greater than 5 lesions, lesions 1 cm or greater, or refractory anemia. However, the American Society of Gastrointestinal Endoscopy guidelines state that type 1 gastric carcinoid surveillance is controversial based on the evidence and could not make an evidence-based position statement on the best treatment modality. Our report illustrates a rare cause of iron deficiency anemia in a young male (without any medical history) due to multiple recurrent gastric carcinoid type 1 lesions in the setting of atrophic gastritis causing hypergastrinemia, and in the absence of a vitamin B12 deficiency. Gastric carcinoid type 1 can present in young males without an autoimmune history, despite the known predilection for women aged 50 to 70 years. Type 1 gastric carcinoids can be managed by endoscopic resection in patients with greater than 5 lesions, even with lesions larger than 1 cm. This course of treatment enabled the avoidance of early antrectomy in our patient, who expressed a preference against more invasive measures at his young age.

Gender preference and implications for screening colonoscopy:Impact of endoscopy nurses

AIM： TO assess the gender preferences, specifically the gender of the nursing staff （endoscopy assistants） and the impact on acceptance for screening colonoscopy （SC）. METHODS： Patients or relatives attending the clinics or health care workers working in a tertiary center were invited to participate in this questionnaire study. The questionnaire enquired on the general demographics （1） age, gender, ethnicity, education level, and employ- ment status, previous history of colonoscopy, family or personal history of colonic pathologies, personal and family history of any cancers; （2） subjects were asked if they would go for an SC if they had appropriate indi- cations （age over 50 years, family history of colorectal cancer （CRC）, fecal occult blood positive, anemia espe- cially iron deficiency anemia, bleeding per rectum with or without loss of appetite, weight loss and abdominal pain） with and without symptoms attributable to CRC; and （3） preferences for the gender of the endoscopists and assistants and whether they would still undergo SC even if their preferences were not met. RESULTS： Eighty-four point seven percent （470/550） completed questionnaire were analysed. More female subjects expressed gender preferences for the endos- copists [overall 70%; female （67.7%） and male （2.3%）] compared to male subjects [overall 62.8%; male （56%） and female （6.8%）, P = 0.102]. Similarly, more female subjects expressed gender preferences for the assis- tants [overall 74.5%; female （73.4%） and male （1.1%）] compared to male subjects [overall 58%, male （49.3%） and female （8.7%）, P 〈 0.001]. Overall, a third would decline an SC, despite having appropriate indications, if their preferences were not met. On univariate analysis, male gender, non-Malay ethnicity （Chinese and others） and previous colonoscopy experience were more likely to undergo an SC, even if their preferences were not met （all P 〈 0.05）. Gender and previous experience fodds ratio （OR） 1.68, 95% confidence interval （CI） 1.00-2.82, P 〈 0.05] with colonoscopy （OR 4.70, 95% CI 1.41-15.66, P 〈 0.05） remained significant on multi variate analysis. CONCLUSION： Genders preference for the endoscopy nurses/assistants is more common than for the endos- copist among women and has implications for the suc cess of a screening colonoscopy program.

Association of Thalassemia and Trait, Sickle Cell and Trait and Haemoglobin C with Iron-Deficiency Anemia in Colombians of African Descent

The conditions of poverty and violence in Colombia have increased the displacement of people of African descent. The research group concerned with the health of these communities has performed research to find the association of alterations in the hemoglobin molecule with the presence of iron deficiency anemia. This research was performed with the support of the epidemiological public health laboratory. The objective of the study is the association of sickle cell disease and sickle cell trait, and the presence of hemoglobin C and its trait, with iron deficiency anemia in Afro-Colombians between 18 and 50 years of age, by investigation of hemograms, peripheral blood study, serum ferritin, soluble receptor for transferrin （sTfR） and index of sTfR, and hemoglobin electrophoresis. This research is a descriptive, quantitative, transverse, structured, non-experimental and correlational study, with a total of 56 samples （10 men, 46 women）. The results showed that ferritin in men had normal values, compared to 32% （15/46） of women who had low levels of ferritin. Men＇s sTfR levels were normal, while in women 2% （1/46） had iron deficiency in stage I, 41% （19/46） iron deficiency in stage If, and 9% （4/46） possibly without anemia iron deficiency. In hemoglobin electrophoresis, 84% （46/56） of the population presents hemoglobin A, 4% （2/56） increased hemoglobin A2 and fetal hemoglobin related to a possible thalassemia trait, 11% （6/56） had hemoglobin AS related to sickle cell trait, and 2% （1/56） show hemoglobin AC, related to hemoglobin AC trait. This project supports investigative and social projects, and also contributes to the improvement of the quality of life and dissemination of good health practices in these communities.

A Decreased Responsiveness of Platelet to Nitric Oxide in Cholesterol-Fed Rabbits

Objective:To determine whether endothelial dysfunction leads to an abnormal responsiveness of platelet to nitric oxide(NO)during the development of atherosclerosis. Methods:Rabbits were fed a 1% cholesterol chow for 12 weeks to induce atherosclerosis.Serum NOx levels and the responsiveness of platelet to NO donor SNP were determined every 4 weeks during maintaining on a chow containing 1% cholesterol.The measurement of serum lipids and the examination of morphological feature and endothelial-dependent relaxation of aorta were performed after 12 weeks of cholesterol diet. Results:Cholesterol diet significantly increased serum levels of cholesterol and LDL,caused a remarkable platelet hyperaggregability,and produced an evident endothelial dysfunction as indicated by the diminished vasorelaxation induced by acetylcholine and endothelial cell lesion as exhibited by scanning electron microscope examination.The percentage of inhibition of ADP-induced platelet aggregation by NO donor SNP was significantly smaller in cholesterol chow group than that in normal chow group although no significant difference in serum NOx levels between normal and cholesterol chow group was observed throughout the development of atherosclerosis. Conclusion:The present study suggests that the endothelial dysfunction caused by enhanced serum cholesterol and LDL levels induces a decreased responsiveness of platelet to NO.

The Potentials of Locally Available Fruits Rich in Iron to Mitigate Iron Deficiency Anemia in Least Developing Countries （LSD）

The objective of this study was to compare effects of natal plum fruits （Carissa grandiflora） on hemoglobin （HB） levels in comparison to ferrous sulfate tablets to 201 anemic children aging from 5 to 12 years in rural area in Somalia. The study was designed as randomized clinical intervention to explore the potentials of natal plum to combat against IDA （iron deficiency anemia）/anemia using mean HB gains as a parameter. The research was carried out in rural setting near Somalia capital where local NGOs （non governmental organizations） work in the absence of local/central authorities. Only HB levels of the subject children were measured as other confirmatory analyses were not available due to the civil wars at the time of the intervention. The baseline HB levels of both groups were similar. However, after the intervention the cumulative HB levels of the natal fruits group was higher than the control group of ferrous sulfate by at least 31% （P 〈 0.008, equal variances not assumed）. Dietary interventions to mitigate IDA/anemia using locally available foods rich in iron, vitamins C and A seem to promise in the developing countries where chronic inadequate resources seem to affect the public health nutrition especially vulnerable groups like growing children.

Overexpression of OsDPR, a novel rice gene highly expressed under iron deficiency, suppresses plant growth

Preliminary microarray analysis of cDNA from rice roots revealed an up-regulated transcript that was highly expressed in a five-day iron deficiency treatment. The entire sequence of this gene was determined by bioinformatics analysis. There were no proteins with significant levels of similarity detected in public databases. This novel gene with unknown biological function was designated as OsDPR (dwarf phenotype-related gene). We constructed a stable plant expression vector pCAM- BIA1302-OsDPR::GFP and produced transgenic tobacco plants. The phenotypes suggested that OsDPR restrained the growth of transformed plants. To understand the mechanisms of this suppression effect, cell size and number were compared between transformants and wild-type plants. The cell proliferation rate was lower in OsDPR transgenic BY-2 cells than in wild-type cells, but OsDPR expression did not affect cell size. Moreover, the cell division-related gene CyclinD2.1, which is involved in plant growth, was down-regulated in transgenic tobacco plants. These findings suggested that the novel iron-regulated gene OsDPR is responsible for the nanism phenotype of transgenic seedlings because of the inhibition of plant cell proliferation.