Anemia The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Antianemic Treatment of Cancer Patients in German Routine Practice: Data from a Prospective Cohort Study—The Tumor Anemia Registry Thu, 04 Feb 2016 06:41:40 +0000 The aim of this prospective cohort study was to assess current antianemic treatment of cancer patients in German routine practice, including diagnostics, treatments, and quality of life (QoL). 88 study sites recruited 1018 patients at the start of antianemic treatment with hemoglobin (Hb) levels <11 g/dL (females) or <12 g/dL (males). Patients were followed up for 12 weeks. 63% of the patients had inoperable solid tumors, 22% operable solid tumors, and 15% hematological malignancies. Over 85% received chemotherapy. Median age was 67 years; 48% were male. Red blood cell transfusions (RBCTx) were given to 59% of all patients and to 55% of the patients with Hb ≥8 g/dL on day 1 of the observation period (day 1 treatment). Erythropoiesis-stimulating agents (ESAs) were the second most frequently applied day 1 treatment (20%), followed by intravenous (IV) iron (15%) and ESA + IV iron (6%). Only about a third of patients were tested for blood serum iron parameters at the start of treatment. Overall, more than half of the patients had long-term responses to antianemic therapy. Our data suggest that in routine practice diagnostics for treatable causes of anemia are underused. A high proportion of cancer patients receive RBCTx. It should be discussed whether thorough diagnostics and earlier intervention could decrease the need for RBCTx. This trial is registered with NCT01795690. Tilman Steinmetz, Jan Schröder, Margarete Plath, Hartmut Link, Michèle Vogt, Melanie Frank, and Norbert Marschner Copyright © 2016 Tilman Steinmetz et al. All rights reserved. Sickle-Cell Disease Healthcare Cost in Africa: Experience of the Congo Tue, 02 Feb 2016 12:04:59 +0000 Background. Lack of medical coverage in Africa leads to inappropriate care that has an impact on the mortality rate. In this study, we aimed to evaluate the cost of severe acute sickle-cell related complications in Brazzaville. Methods. A retrospective study was conducted in 2014 in the Paediatric Intensive Care Unit. It concerned 94 homozygote sickle-cell children that developed severe acute sickle-cell disease related complications (average age 69 months). For each patient, we calculated the cost of care complication. Results. The household income was estimated as low (<XAF 90,000/<USD 158.40) in 27.7%. The overall median cost for hospitalization for sickle-cell related acute complications was XAF 65,460/USD 115.21. Costs were fluctuating depending on the generating factors of the severe acute complications (). They were higher in case of complications generated by bacterial infections (ranging from XAF 66,765/USD 117.50 to XAF 135,271.50/USD 238.07) and lower in case of complications associated with malaria (ranging from XAF 28,305/49.82 to XAF 64,891.63/USD 114.21). The mortality rate was 17% and was associated with the cost of the case management (). Conclusion. The case management cost of severe acute complications of sickle-cell disease in children is high in Congo. L. O. Ngolet, M. Moyen Engoba, Innocent Kocko, Alexis Elira Dokekias, Jean-Vivien Mombouli, and Georges Marius Moyen Copyright © 2016 L. O. Ngolet et al. All rights reserved. The Cost-Effectiveness of Continuous Erythropoiesis Receptor Activator Once Monthly versus Epoetin Thrice Weekly for Anaemia Management in Chronic Haemodialysis Patients Wed, 30 Dec 2015 07:59:55 +0000 Introduction. The aim of this study was to compare the cost-effectiveness of continuous erythropoietin receptor activator (CERA) once monthly to epoetin beta (EpoB) thrice weekly to maintain haemoglobin (Hb) within the range 10.5–12 g/dL. Methods. Prospective cohort study and cost-effectiveness analysis. Chronic haemodialysis patients (CHP), being treated with EpoB, were selected for two periods of follow-up: period 1, maintaining prior treatment with EpoB, and period 2, conversion to CERA once monthly. Hb concentrations and costs were measured monthly. Health care payer perspective for one year was adopted. Results. 75 CHP completed the study, with a mean age of years. Baseline Hb was  g/dL in EpoB phase and  g/dL in CERA phase; we observed a significant increase in the proportion of patients successfully treated (Hb within the recommended range), 65.3% versus 70.7%, : 0.008, and in the average effectiveness by 4% (0.55 versus 0.59). Average cost-effectiveness ratios were 6013.86 and 5173.64$, with an ICER CERA to EpoB at −6457.5$. Conclusion. Our health economic evaluation of ESA use in haemodialysis patients suggests that the use of CERA is cost-effective compared with EpoB. Omar Maoujoud, Samir Ahid, Hocein Dkhissi, Zouhair Oualim, and Yahia Cherrah Copyright © 2015 Omar Maoujoud et al. All rights reserved. Hyperglycaemic Environment: Contribution to the Anaemia Associated with Diabetes Mellitus in Rats Experimentally Induced with Alloxan Mon, 30 Nov 2015 13:32:29 +0000 Background. Diabetes mellitus characterized by hyperglycaemia presents with various complications amongst which anaemia is common particularly in those with overt nephropathy or renal impairment. The present study has examined the contribution of the hyperglycaemic environment in diabetic rats to the anaemia associated with diabetes mellitus. Method. Sixty male albino rats weighing 175–250 g were selected for this study and divided equally into control and test groups. Hyperglycaemia was induced with 170 kgbwt−1 alloxan intraperitoneally in the test group while control group received sterile normal saline. Blood samples obtained from the control and test rats were assayed for packed cell volume (PCV), haemoglobin (Hb), red blood cell count (RBC), reticulocyte count, glucose, plasma haemoglobin, potassium, and bilirubin. Result. Significant reduction () in PCV ( versus ) and haemoglobin ( versus ) with significant increase () in reticulocyte count ( versus ), plasma haemoglobin ( versus ), and potassium ( versus ) was obtained in the test while plasma bilirubin showed nonsignificant increase ( versus ). Conclusion. The increased plasma haemoglobin and potassium levels indicate an intravascular haemolytic event while the nonsignificant increased bilirubin showed extravascular haemolysis. These play contributory roles in the anaemia associated with diabetes mellitus. Oseni Bashiru Shola and Fakoya Olatunde Olugbenga Copyright © 2015 Oseni Bashiru Shola and Fakoya Olatunde Olugbenga. All rights reserved. Prevalence and Risk Factors for Complications in Patients with Nontransfusion Dependent Alpha- and Beta-Thalassemia Wed, 18 Nov 2015 11:47:35 +0000 Background. Nontransfusion dependent thalassemia (NTDT) is a milder form of thalassemia that does not require regular transfusion. It is associated with many complications, which differ from that found in transfusion-dependent thalassemia (TDT). Currently available information is mostly derived from beta-NTDT; consequently, more data is needed to describe complications found in the alpha-NTDT form of this disease. Methods. We retrospectively reviewed the medical records of NTDT patients from January 2012 to December 2013. Complications related to thalassemia were reviewed and compared. Results. One hundred patients included 60 females with a median age of 38 years. The majority (54 patients) had alpha-thalassemia. Overall, 83 patients had one or more complications. The three most common complications were cholelithiasis (35%), abnormal liver function (29%), and extramedullary hematopoiesis (EMH) (25%). EMH, cardiomyopathy, cholelithiasis, and pulmonary hypertension were more commonly seen in beta-thalassemia. Osteoporosis was the only complication that was more common in alpha-thalassemia. The risk factors significantly related to EMH were beta-thalassemia type and hemoglobin < 8 g/dL. The risk factors related to osteoporosis were female gender and age > 40 years. Iron overload (ferritin > 800 ng/mL) was the only risk factor for abnormal liver function. Conclusion. The prevalence of alpha-NTDT complications was lower and different from beta-thalassemia. Poramed Winichakoon, Adisak Tantiworawit, Thanawat Rattanathammethee, Sasinee Hantrakool, Chatree Chai-Adisaksopha, Ekarat Rattarittamrong, Lalita Norasetthada, and Pimlak Charoenkwan Copyright © 2015 Poramed Winichakoon et al. All rights reserved. Anemia in Patients with Type 2 Diabetes Mellitus Wed, 11 Nov 2015 08:22:22 +0000 The objective of this study was to evaluate the prevalence of anemia in DM2 patients and its correlation with demographic and lifestyle and laboratory variables. This is a descriptive and analytical study of the type of case studies in the urban area of the Ijuí city, registered in programs of the Family Health Strategy, with a total sample of 146 patients with DM2. A semistructured questionnaire with sociodemographic and clinical variables and performed biochemical test was applied. Of the DM2 patients studied, 50 patients had anemia, and it was found that the body mass items and hypertension and hematological variables are significantly associated with anemia of chronic disease. So, the prevalence of anemia is high in patients with DM2. The set of observed changes characterizes the anemia of chronic disease, which affects quality of life of diabetic patients and is associated with disease progression, development, and comorbidities that contribute significantly to increasing the risk of cardiovascular diseases. Jéssica Barbieri, Paula Caitano Fontela, Eliane Roseli Winkelmann, Carine Eloise Prestes Zimmermann, Yana Picinin Sandri, Emanelle Kerber Viera Mallet, and Matias Nunes Frizzo Copyright © 2015 Jéssica Barbieri et al. All rights reserved. Hospitalization Events among Children and Adolescents with Sickle Cell Disease in Basra, Iraq Mon, 26 Oct 2015 08:24:02 +0000 Objectives. Despite improvements in the management of sickle cell disease (SCD), many patients still experience disease-related complications requiring hospitalizations. The objectives of this study were to identify causes of hospitalization among these patients and factors associated with the length of hospital stay (LOS) and readmission. Methods. Data from 160 patients (<14 years old) with SCD who were admitted to the Basra Maternity and Children’s Hospital from the first of January 2012 through July 2012 were analyzed. Results. The main causes of hospitalization were acute painful crises (73.84%), infections (9.28%), acute chest syndrome (8.02%), and acute splenic sequestration crisis (6.32%). The mean LOS was days. The LOS for patients on hydroxyurea ( days) was shorter than that for patients who were not ( days), . The readmission rate (23.1%) was significantly higher among patients with frequent hospitalizations in the previous year (OR 9.352, 95% CI 2.011–43.49), asthma symptoms (OR 4.225, 95% CI 1.125–15.862), and opioid use (OR 6.588, 95% CI 1.104–30.336). Patients on hydroxyurea were less likely to be readmitted (OR 0.082, 95% CI 0.10–0.663). Conclusions. There is a relatively high readmission rate among patients with SCD in Basra. The use of hydroxyurea significantly decreases the LOS and readmission rate. Zeina A. Salman and Meaad K. Hassan Copyright © 2015 Zeina A. Salman and Meaad K. Hassan. All rights reserved. Reproductive and Obstetric Factors Are Key Predictors of Maternal Anemia during Pregnancy in Ethiopia: Evidence from Demographic and Health Survey (2011) Mon, 31 Aug 2015 11:57:47 +0000 Anemia is a major public health problem worldwide. In Ethiopia, a nationally representative and consistent evidence is lacking on the prevalence and determinants during pregnancy. We conducted an in-depth analysis of demographic and health survey for the year 2011 which is a representative data collected from all regions in Ethiopia. Considering maternal anemia as an outcome variable, predicting variables from sociodemographic, household, and reproductive/obstetric characteristics were identified for analyses. Logistic regression model was applied to identify predictors at . The prevalence of anemia among pregnant women was 23%. Maternal age, region, pregnancy trimester, number of under five children, previous history of abortion (termination of pregnancy), breastfeeding practices, and number of antenatal care visits were key independent predictors of anemia during pregnancy. In conclusion, the level of anemia during pregnancy is a moderate public health problem in Ethiopia. Yet, special preventive measures should be undertaken for pregnant women who are older in age and having too many under five children and previous history of abortion. Further evidence is expected to be generated concerning why pregnant mothers from the eastern part of the country and those with better access to radio disproportionately develop anemia more than their counterparts. Taddese Alemu and Melaku Umeta Copyright © 2015 Taddese Alemu and Melaku Umeta. All rights reserved. Intravenous Iron Therapy in Patients with Iron Deficiency Anemia: Dosing Considerations Wed, 15 Jul 2015 06:08:31 +0000 Objective. To provide clinicians with evidence-based guidance for iron therapy dosing in patients with iron deficiency anemia (IDA), we conducted a study examining the benefits of a higher cumulative dose of intravenous (IV) iron than what is typically administered. Methods. We first individually analyzed 5 clinical studies, averaging the total iron deficit across all patients utilizing a modified Ganzoni formula; we then similarly analyzed 2 larger clinical studies. For the second of the larger studies (Study 7), we also compared the efficacy and retreatment requirements of a cumulative dose of 1500 mg ferric carboxymaltose (FCM) to 1000 mg iron sucrose (IS). Results. The average iron deficit was calculated to be 1531 mg for patients in Studies 1–5 and 1392 mg for patients in Studies 6-7. The percentage of patients who were retreated with IV iron between Days 56 and 90 was significantly () lower (5.6%) in the 1500 mg group, compared to the 1000 mg group (11.1%). Conclusions. Our data suggests that a total cumulative dose of 1000 mg of IV iron may be insufficient for iron repletion in a majority of patients with IDA and a dose of 1500 mg is closer to the actual iron deficit in these patients. Todd A. Koch, Jennifer Myers, and Lawrence Tim Goodnough Copyright © 2015 Todd A. Koch et al. All rights reserved. Efficacy and Safety of Intravenous Ferric Carboxymaltose in Geriatric Inpatients at a German Tertiary University Teaching Hospital: A Retrospective Observational Cohort Study of Clinical Practice Sun, 05 Jul 2015 08:59:07 +0000 Current iron supplementation practice in geriatric patients is erratic and lacks evidence-based recommendations. Despite potential benefits in this population, intravenous iron supplementation is often withheld due to concerns regarding pharmacy expense, perceived safety issues, and doubts regarding efficacy in elderly patients. This retrospective, observational cohort study aimed to evaluate the safety and efficacy of intravenous ferric carboxymaltose (FCM, Ferinject) in patients aged >75 years with iron deficiency anaemia (IDA). Within a twelve-month data extraction period, the charts of 405 hospitalised patients aged 65–101 years were retrospectively analysed for IDA, defined according to WHO criteria for anaemia (haemoglobin: <13.0 g/dL (m)/<12.0 g/dL (f)) in conjunction with transferrin saturation <20%. Of 128 IDA patients screened, 51 (39.8%) received intravenous iron. 38 patient charts were analysed. Mean cumulative dose of intravenous FCM was 784.4 ± 271.7 mg iron (1–3 infusions). 18 patients (47%) fulfilled treatment response criteria (≥1.0 g/dL increase in haemoglobin between baseline and hospital discharge). AEs were mild/moderate, most commonly transient increases of liver enzymes (n = 5/13.2%). AE incidence was comparable with that observed in patients <75 years. No serious AEs were observed. Ferric carboxymaltose was well tolerated and effective for correction of Hb levels and iron stores in this cohort of IDA patients aged over 75 years. Matthias Bach, Tabea Geisel, Julia Martin, Bettina Schulze, Roland Schaefer, Garth Virgin, and Juergen Stein Copyright © 2015 Matthias Bach et al. All rights reserved. Magnitude of Anemia and Associated Factors among Pediatric HIV/AIDS Patients Attending Zewditu Memorial Hospital ART Clinic, Addis Ababa, Ethiopia Tue, 24 Mar 2015 10:02:03 +0000 Background. Anemia is one of the most commonly observed hematological abnormalities and an independent prognostic marker of HIV disease. The aim of this study was to determine the magnitude of anemia and associated factors among pediatric HIV/AIDS patients attending Zewditu Memorial Hospital (ZMH) ART Clinic in Addis Ababa, Ethiopia. Methods. A cross-sectional study was conducted among pediatric HIV/AIDS patients of Zewditu Memorial Hospital (ZMH) between August 05, 2013, and November 25, 2013. A total of 180 children were selected consecutively. Stool specimen was collected and processed. A structured questionnaire was used to collect data on sociodemographic characteristics and associated risk factors. Data were entered into EpiData 3.1.1. and were analyzed using SPSS version 16 software. Logistic regressions were applied to assess any association between explanatory factors and outcome variables. Results. The total prevalence of anemia was 22.2% where 21 (52.5%), 17 (42.5%), and 2 (5.0%) patients had mild, moderate, and severe anemia. There was a significant increase in severity and prevalence of anemia in those with CD4+ T cell counts below 350 cells/μL (). Having intestinal parasitic infections (AOR = 2.7, 95% CI, 1.1–7.2), having lower CD4+ T cell count (AOR = 3.8, 95% CI, 1.6–9.4), and being HAART naïve (AOR = 2.3, 95% CI, 1.6–9.4) were identified as significant predictors of anemia. Conclusion. Anemia was more prevalent and severe in patients with low CD4+ T cell counts, patients infected with intestinal parasites/helminthes, and HAART naïve patients. Therefore, public health measures and regular follow-up are necessary to prevent anemia. Hylemariam Mihiretie, Bineyam Taye, and Aster Tsegaye Copyright © 2015 Hylemariam Mihiretie et al. All rights reserved. Attitudes toward Management of Sickle Cell Disease and Its Complications: A National Survey of Academic Family Physicians Sun, 22 Feb 2015 13:32:44 +0000 Objective. Sickle cell disease (SCD) is a disease that requires a significant degree of medical intervention, and family physicians are one potential provider of care for patients who do not have access to specialists. The extent to which family physicians are comfortable with the treatment of and concerned about potential complications of SCD among their patients is unclear. Our purpose was to examine family physician’s attitudes toward SCD management. Methods. Data was collected as part of the Council of Academic Family Medicine Educational Research Alliance (CERA) survey in the United States and Canada that targeted family physicians who were members of CERA-affiliated organizations. We examined attitudes regarding management of SCD. Results. Overall, 20.4% of respondents felt comfortable with treatment of SCD. There were significant differences in comfort level for treatment of SCD patients depending on whether or not physicians had patients who had SCD, as well as physicians who had more than 10% African American patients. Physicians also felt that clinical decision support (CDS) tools would be useful for treatment (69.4%) and avoiding complications (72.6%) in managing SCD patients. Conclusions. Family physicians are generally uncomfortable with managing SCD patients and recognize the utility of CDS tools in managing patients. Arch G. Mainous III, Rebecca J. Tanner, Christopher A. Harle, Richard Baker, Navkiran K. Shokar, and Mary M. Hulihan Copyright © 2015 Arch G. Mainous III et al. All rights reserved. Effect of Maternal Iron Deficiency Anemia on the Iron Store of Newborns in Ethiopia Wed, 04 Feb 2015 08:17:09 +0000 Iron deficiency anemia among pregnant women is a widespread problem in developing countries including Ethiopia, though its influence on neonatal iron status was inconsistently reported in literature. This cross-sectional study was conducted to compare hematologic profiles and iron status of newborns from mothers with different anemia status and determine correlation between maternal and neonatal hematologic profiles and iron status in Ethiopian context. We included 89 mothers and their respective newborns and performed complete blood count and assessed serum ferritin and C-reactive protein levels from blood samples collected from study participants. Maternal median hemoglobin and serum ferritin levels were 12.2 g/dL and 47.0 ng/mL, respectively. The median hemoglobin and serum ferritin levels for the newborns were 16.2 g/dL and 187.6 ng/mL, respectively. The mothers were classified into two groups based on hemoglobin and serum ferritin levels as iron deficient anemic (IDA) and nonanemic (NA) and newborns of IDA mothers had significantly lower levels of serum ferritin () and hemoglobin concentration (). Besides, newborns’ ferritin and hemoglobin levels showed significant correlation with maternal hemoglobin (; ) and ferritin (; ) levels. We concluded that maternal IDA may have an effect on the iron stores of newborns. Betelihem Terefe, Asaye Birhanu, Paulos Nigussie, and Aster Tsegaye Copyright © 2015 Betelihem Terefe et al. All rights reserved. Management of Sickle Cell Disease: A Review for Physician Education in Nigeria (Sub-Saharan Africa) Sun, 18 Jan 2015 07:20:27 +0000 Sickle cell disease (SCD) predominates in sub-Saharan Africa, East Mediterranean areas, Middle East, and India. Nigeria, being the most populous black nation in the world, bears its greatest burden in sub-Saharan Africa. The last few decades have witnessed remarkable scientific progress in the understanding of the complex pathophysiology of the disease. Improved clinical insights have heralded development and establishment of disease modifying interventions such as chronic blood transfusions, hydroxyurea therapy, and haemopoietic stem cell transplantation. Coupled with parallel improvements in general supportive, symptomatic, and preventive measures, current evidence reveals remarkable appreciation in quality of life among affected individuals in developed nations. Currently, in Nigeria and other West African states, treatment and control of SCD are largely suboptimal. Improved knowledge regarding SCD phenotypes and its comprehensive care among Nigerian physicians will enhance quality of care for affected persons. This paper therefore provides a review on the aetiopathogenesis, clinical manifestations, and management of SCD in Nigeria, with a focus on its local patterns and peculiarities. Established treatment guidelines as appropriate in the Nigerian setting are proffered, as well as recommendations for improving care of affected persons. Ademola Samson Adewoyin Copyright © 2015 Ademola Samson Adewoyin. All rights reserved. A Retrospective Study Investigating the Incidence and Predisposing Factors of Hospital-Acquired Anemia Sun, 21 Dec 2014 11:18:31 +0000 Hospitalized patients frequently have considerable volumes of blood removed for diagnostic testing which could lead to the development of hospital-acquired anemia. Low hemoglobin levels during hospitalization may result in significant morbidity for patients with underlying cardiorespiratory and other illnesses. We performed a retrospective study and data was collected using a chart review facilitated through an electronic medical record. A total of 479 patients who were not anemic during admission were included in analysis. In our study, we investigated the incidence of HAA and found that, between admission and discharge, 65% of patients dropped their hemoglobin by 1.0 g/dL or more, and 49% of patients developed anemia. We also found that the decrease in hemoglobin between admission and discharge did not differ significantly with smaller phlebotomy tubes. In multivariate analysis, we found that patients with longer hospitalization and those with lower BMI are at higher risk of developing HAA. In conclusion, our study confirms that hospital-acquired anemia is common. More aggressive strategies such as reducing the frequency of blood draws and expanding the use of smaller volume tubes for other laboratory panels may be helpful in reducing the incidence of HAA during hospitalization. Peter C. Kurniali, Stephanie Curry, Keith W. Brennan, Kim Velletri, Mohammed Shaik, Kenneth A. Schwartz, and Elise McCormack Copyright © 2014 Peter C. Kurniali et al. All rights reserved. Prevalence and Severity of Anaemia Stratified by Age and Gender in Rural India Thu, 04 Dec 2014 12:26:03 +0000 Anaemia is a major public health problem in India. Although nearly three quarters of the Indian population live in rural areas, the epidemiology of anaemia in rural settings is not well known. We performed a retrospective observational study using routine clinical data from patients attending the out-patient clinics of a rural hospital in India from June 2011 to August 2014. The study included 73,795 determinations of haemoglobin. 49.5% of patients were female. The median haemoglobin concentration was 11.3 g/dL (interquartile range (IQR), 9.8–12.4) in females and 12.5 g/dL (IQR, 10.6–14.2) in males. Anaemia was present in the majority of children <10 years, women after puberty, and older adults. Children <5 years had the highest prevalence of anaemia, especially children aged 1-2 years. The high proportion of microcytic anaemia and the fact that gender differences were only seen after the menarche period in women suggest that iron deficiency was the main cause of anaemia. However, the prevalence of normocytic anaemia increased with age. The results of this study can be used by public health programmes to design target interventions aimed at reducing the huge burden of anaemia in India. Further studies are needed to clarify the aetiology of anaemia among older adults. Gerardo Alvarez-Uria, Praveen K. Naik, Manoranjan Midde, Pradeep S. Yalla, and Raghavakalyan Pakam Copyright © 2014 Gerardo Alvarez-Uria et al. All rights reserved. Correlation between Plasma Interleukin-3, the α/β Globin Ratio, and Globin mRNA Stability Tue, 18 Nov 2014 06:24:31 +0000 Background. Globin chain synthesis (GCS) analysis is used in the diagnosis of thalassemia. However, the wide reference range limits its use as a decisive diagnostic tool. It has been shown that α and β  globin mRNA increase through stimulation of cells by interleukin-3 (IL-3). Therefore, this study investigates the relationship between plasma IL-3 and the β/α  globin ratio. Methods. Blood samples were collected from 32 healthy participants on two occasions one month apart. GCS analysis, real-time PCR, and ELISA tests were conducted to determine the β/α  globin ratio, globin mRNA expression and stability rate, and IL-3 levels. Results. On the basis of IL-3 levels, the participants were divided in two groups. One group included participants who showed a significant increase in IL-3 as indicated by a significant rise in mean values of α, β, and γ  globin mRNA, α and β  globin, RBC, and hemoglobin. The other group included participants who showed no difference in IL-3 levels with no significant variations in the above-mentioned parameters. Conclusion. The results of this study indicate that IL-3 has an equivalent positive effect on α and β  globin chain synthesis. Therefore, IL-3 levels do not explain the wide reference range of the α/β  globin ratio. S. Rouhi Dehnabeh, R. Mahdian, S. Ajdary, E. Mostafavi, and S. Khatami Copyright © 2014 S. Rouhi Dehnabeh et al. All rights reserved. Validity of Palmar Pallor for Diagnosis of Anemia among Children Aged 6–59 Months in North India Sun, 09 Nov 2014 11:21:08 +0000 Introduction. The Integrated Management of Childhood and Neonatal Illness (IMNCI) recommends the use palmar pallor to diagnose anaemia. Earlier studies to validate palmar pallor as clinical sign for anaemia were largely done in African context. There was a need to test validity of palmar pallor to detect anemia in different settings. Objective. To study the validity and interobserver agreement of palmar pallor examination to diagnose anemia in children under 5 years of age in India. Methods. In a village in Northern India, hemoglobin estimation was done for 80 children using cyanomethemoglobin method. Two examiners, a physician and a health worker, trained in IMNCI evaluated children for palmar pallor. Sensitivity and specificity and Kappa statistics were calculated. Results. Health worker diagnosed palmar pallor with sensitivity of 30.8–42.8% and specificity of 70–89%. Similar figures for doctor were 40–47% and 60–66%, respectively. Kappa agreement between a health worker and a physician was 0.48 (95% CI = 0.298–0.666) and then increased to 0.51 when categories of severe pallor and mild pallor were merged. Conclusion. While using palmar pallor as clinical sign for anaemia, children with no pallor should also be followed up closely for possible detection of missed cases during follow-up. Arun Kumar Aggarwal, Jaya Prasad Tripathy, Deepak Sharma, and Ajith Prabhu Copyright © 2014 Arun Kumar Aggarwal et al. All rights reserved. Study of Hematological Parameters in Children Suffering from Iron Deficiency Anaemia in Chattagram Maa-o-Shishu General Hospital, Chittagong, Bangladesh Tue, 21 Oct 2014 08:45:29 +0000 A total of 150 (30.61%) anemic patients out of 490 patients diagnosed to have iron deficiency anemia (IDA) have been selected for the first time in Bangladesh. For detailed study, blood samples from 150 anemic patients along with 25 controls were analyzed. Analysis of variance showed significant value between mean platelet volume (MPV) in females (8.08 μm3) and males (7.59 μm3) () in iron deficiency anemia patients. Besides, the value of white blood cells (WBC) in males (10946.08/cmm) was significantly higher than in females (9470.833/cmm) (). The significant correlation was observed among hemoglobin levels with hematocrits, hemoglobin with RBC, RBC with hematocrits, and MCV with MCH as well as MCH with MCHC. However, the negative correlation was observed between the hematological variables neutrophils and lymphocytes (). The common complaints we have found in the survey were weight loss 73.33%, attention problem 68%, dyspepsia 65%, decrease of appetite 72%, weakness 68%, diarrhea 65%, and headache 55% among IDA patients. ANOVA showed significant statistical difference in all the hematological and biochemical parameters. Analysis of variance test between anemias with only one of three biochemical parameters decreased and control showed that this group does not have iron deficiency. Abu Syed Mohammed Mujib, Abu Sayeed Mohammad Mahmud, Milton Halder, and Chowdhury Mohammad Monirul Hasan Copyright © 2014 Abu Syed Mohammed Mujib et al. All rights reserved. Anaemia among Female Undergraduates Residing in the Hostels of University of Sri Jayewardenepura, Sri Lanka Mon, 22 Sep 2014 06:01:55 +0000 Anaemia is a major public health problem that has affected around 25% of the world’s population. An analytical cross-sectional study was performed on 313 female undergraduates residing in hostels of University of Sri Jayewardenepura, Sri Lanka, during year 2011. Objective of this study was to determine prevalence and contributing factors to anaemia among the study population. Haemoglobin concentration was assayed using cyanomethaemoglobin method. A pretested self-administered questionnaire was used to retrieve information regarding dietary habits and personal factors of participants. Descriptive statistical methods, chi-square test, and independent sample t-test were used to analyze data. Of the 302 females, 17.5% () had mild anaemia and 7.9% () had moderate anaemia. Severely anaemic individuals were not observed. Participants’ dietary habits and personal factors were not significantly associated with prevalence of anaemia (whether a participant is a vegetarian or not (), drinking tea within one hour of a meal (), frequency of consumption of red meat, fish, and eggs (), antihelminthic treatment within past year (), and menorrhagia ()). Anaemia in the study population is below the average for Sri Lankan data. Diet and selected medical conditions were not a causative factor for anaemia in this population. Gayashan Chathuranga, Thushara Balasuriya, and Rasika Perera Copyright © 2014 Gayashan Chathuranga et al. All rights reserved. Determinants of Anemia among Children Aged 6–59 Months Living in Kilte Awulaelo Woreda, Northern Ethiopia Mon, 15 Sep 2014 00:00:00 +0000 Introduction. The aim of this study was to determine the prevalence of anemia and determinant factors among children aged 6–59 months living in Kilte Awulaelo Woreda, eastern zone. Method. A community based cross-sectional study was conducted during February 2013 among 6 tabias of Kilte Awulaelo Woreda, northern Ethiopia. A total of 568 children were selected by systematic random sampling method. Anthropometric data and blood sample were collected. Bivariate and multivariate logistic regression analyses were performed to identify factors related to anemia. Result. The mean hemoglobin level was 11.48 g/dl and about 37.3% of children were anemic. Children who were aged 6–23 months [AOR = 1.89: 95% CI (1.3, 2.8)], underweight [AOR = 2.05: 95% CI (1.3, 3.3)], having MUAC less than 12 cm [AOR = 3.35: 95% CI (2.1, 5.3)], and from households with annual income below 10,000 Ethiopian birr [AOR = 4.86: 95% CI (3.2, 7.3)] were more likely to become anemic. Conclusion. The prevalence of anemia among the children is found to be high. It was associated with annual household income, age, and nutritional status of the child. So, improving family income and increasing awareness of the mother/caregiver were important intervention. Gebremedhin Gebreegziabiher, Belachew Etana, and Daniel Niggusie Copyright © 2014 Gebremedhin Gebreegziabiher et al. All rights reserved. Prevalence of Anemia and Associated Factors among Pregnant Women in an Urban Area of Eastern Ethiopia Mon, 25 Aug 2014 11:06:13 +0000 This research work presents the magnitude of anemia and its determinant factors among pregnant women. As far as this research is done in the eastern part of Ethiopia, where there is a different cultural issue related to pregnancy and dietary habit, it will help the researchers to know the problem in different parts of the country. Kefyalew Addis Alene and Abdulahi Mohamed Dohe Copyright © 2014 Kefyalew Addis Alene and Abdulahi Mohamed Dohe. All rights reserved. Assessment of Serum Zinc Levels of Patients with Thalassemia Compared to Their Siblings Thu, 14 Aug 2014 11:06:48 +0000 Zinc (Zn) is essential for appropriate growth and proper immune function, both of which may be impaired in thalassemia children. Factors that can affect serum Zn levels in these patients may be related to their disease or treatment or nutritional causes. We assessed the serum Zn levels of children with thalassemia paired with a sibling. Zn levels were obtained from 30 children in Islamabad, Pakistan. Serum Zn levels and anthropometric data measures were compared among siblings. Thalassemia patients’ median age was 4.5 years (range 1–10.6 years) and siblings was 7.8 years (range 1.1–17 years). The median serum Zn levels for both groups were within normal range: 100 μg/dL (10 μg/dL–297 μg/dL) for patients and 92 μg/dL (13 μg/dL–212 μg/dL) for siblings. There was no significant difference between the two groups. Patients’ serum Zn values correlated positively with their corresponding siblings (, ). There were no correlations between patients’ Zn levels, height for age Z-scores, serum ferritin levels, chelation, or blood counts (including both total leukocyte and absolute lymphocyte counts). Patients’ serum Zn values correlated with their siblings’ values. In this study, patients with thalassemia do not seem to have disease-related Zn deficiency. Mohamed El Missiry, Mohamed Hamed Hussein, Sadaf Khalid, Naila Yaqub, Sarah Khan, Fatima Itrat, Cornelio Uderzo, and Lawrence Faulkner Copyright © 2014 Mohamed El Missiry et al. All rights reserved. Presence and Characterisation of Anaemia in Diabetic Foot Ulceration Wed, 23 Jul 2014 09:32:04 +0000 Introduction. Diabetic foot ulceration (DFU) is the commonest cause of severe limb ischaemia in the western world. In diabetes mellitus, anaemia is frequently unrecognized, yet studies have shown that it is twice as common in diabetics compared with nondiabetics. We aimed to assess the incidence of anaemia and further classify the iron deficiency seen in a high-risk DFU patient group. Methods. An observational study was undertaken in a multidisciplinary diabetic foot clinic setting. All patients with DFU attending over a four-month period were included. Anaemia was defined as haemoglobin (Hb) levels <12 g/dL. Iron deficiency was classified according to definitions of AID (absolute iron deficiency) and FID (functional iron deficiency). Results. 27 patients had DFU; 14 (51.9%) were anaemic; two (7.41%) had severe anaemia (Hb < 10 g/dL). No patient had B12 or Folate deficiency. In patients with anaemia, there was significant spread of indices. Only one patient had “textbook” absolute iron deficiency (AID) defined as low Hb, MCV, MCH, and ferritin. Functional iron deficiency (FID) was seen in a further seven patients (25.5%). Conclusion. Anaemia and iron deficiency are a common problem in patients with DFU. With current clinical markers, it is incredibly difficult to determine causal relationships and further in-depth scientific study is required. J. A. Wright, M. J. Oddy, and T. Richards Copyright © 2014 J. A. Wright et al. All rights reserved. Extent of Anaemia among Preschool Children in EAG States, India: A Challenge to Policy Makers Wed, 23 Jul 2014 00:00:00 +0000 Background. India is the highest contributor to child anemia. About 89 million children in India are anemic. The study determines the factors that contributed to child anemia and examines the role of the existing programs in reducing the prevalence of child anemia particularly in the EAG states. Methods. The data from the latest round of the National Family Health Survey (NFHS-3) is used. Simple bivariate and multinomial logistics regression analyses are used. Results. About 70% children are anemic in all the EAG states. The prevalence of severe anemia is the highest (6.7%) in Rajasthan followed by Uttar Pradesh (3.6%) and Madhya Pradesh (3.4%). Children aged 12 to 17 months are significantly seven times (, ) more likely to be severely anemic compared to children of 36 to 59 months. Children of severely anemic mothers are also found to be more severely anemic (, ) than the children of not anemic mothers. Conclusions. The study reveals that the existing government program fails to control anemia among preschool children in the backward states of India. Therefore, there is an urgent need for monitoring of program in regular interval, particularly for EAG states to reduce the prevalence of anemia among preschool children. Rakesh Kumar Singh and Shraboni Patra Copyright © 2014 Rakesh Kumar Singh and Shraboni Patra. All rights reserved. Cormic Index Profile of Children with Sickle Cell Anaemia in Lagos, Nigeria Thu, 17 Apr 2014 11:43:37 +0000 Background. Sickle cell disorders are known to have a negative effect on linear growth. This could potentially affect proportional growth and, hence, Cormic Index. Objective. To determine the Cormic Index in the sickle cell anaemia population in Lagos. Methodology. A consecutive sample of 100 children with haemoglobin genotype SS, aged eight months to 15 years, and 100 age and sex matched controls (haemoglobin genotype AA) was studied. Sitting height (upper segment) and full length or height were measured. Sitting height was then expressed as a percentage of full length/height (Cormic Index). Results. The mean Cormic Index decreased with age among primary subjects (SS) and AA controls. The overall mean Cormic Index among primary subjects was comparable to that of controls (% versus %; % versus %) in boys and girls, respectively. In comparison with AA controls, female children with sickle cell anaemia who were older than 10 years had a significantly lower mean Cormic Index. Conclusion. There was a significant negative relationship between Cormic Index and height in subjects and controls irrespective of gender. Similarly, a significant negative correlation existed between age, sitting height, subischial leg length, weight, and Cormic Index in both subjects and controls. Samuel Olufemi Akodu, Olisamedua Fidelis Njokanma, and Omolara Adeolu Kehinde Copyright © 2014 Samuel Olufemi Akodu et al. All rights reserved. Validation of the WHO Hemoglobin Color Scale Method Tue, 15 Apr 2014 14:06:42 +0000 This study was carried out to evaluate the diagnostic accuracy of WHO color scale in screening anemia during blood donor selection in Sri Lanka. A comparative cross-sectional study was conducted by the Medical Laboratory Sciences Unit of University of Sri Jayewardenepura in collaboration with National Blood Transfusion Centre, Sri Lanka. A total of 100 subjects participated in this study. Hemoglobin value of each participant was analyzed by both WHO color scale method and cyanmethemoglobin method. Bland-Altman plot was used to determine the agreement between the two methods. Sensitivity, specificity, predictive values, false positive, and negative rates were calculated. The sensitivity of the WHO color scale was very low. The highest sensitivity observed was 55.55% in hemoglobin concentrations >13.1 g/dL and the lowest was 28.57% in hemoglobin concentrations between 7.1 and 9.0 g/dL. The mean difference between the WHO color scale and the cyanmethemoglobin method was 0.2 g/dL (95% confidence interval; 3.2 g/dL above and 2.8 g/dL below). Even though the WHO color scale is an inexpensive and portable method for field studies, from the overall results in this study it is concluded that WHO color scale is an inaccurate method to screen anemia during blood donations. Leeniyagala Gamaralalage Thamal Darshana and Deepthi Inoka Uluwaduge Copyright © 2014 Leeniyagala Gamaralalage Thamal Darshana and Deepthi Inoka Uluwaduge. All rights reserved. Hematological Indices for Differential Diagnosis of Beta Thalassemia Trait and Iron Deficiency Anemia Thu, 10 Apr 2014 09:08:25 +0000 Background. The two most frequent types of microcytic anemia are beta thalassemia trait (β-TT) and iron deficiency anemia (IDA). We retrospectively evaluated the reliability of various indices for differential diagnosis of microcytosis and β-TT in the same patient groups. Methods. A total of 290 carefully selected children aged 1.1–16 years were evaluated. We calculated 12 discrimination indices in all patients with hemoglobin (Hb) values of 8.7–11.4 g/dL. None of the subjects had a combined case of IDA and β-TT. All children with IDA received oral iron for 16 weeks, and HbA2 screening was performed after iron therapy. The patient groups were evaluated according to red blood cell (RBC) count; red blood distribution width index; the Mentzer, Shine and Lal, England and Fraser, Srivastava and Bevington, Green and King, Ricerca, Sirdah, and Ehsani indices; mean density of hemoglobin/liter of blood; and mean cell density of hemoglobin. Results. The Mentzer index was the most reliable index, as it had the highest sensitivity (98.7%), specificity (82.3%), and Youden’s index (81%) for detecting β-TT; this was followed by the Ehsani index (94.8%, 73.5%, and 68.3%, resp.) and RBC count (94.8%, 70.5%, and 65.3%). Conclusion. The Mentzer index provided the highest reliabilities for differentiating β-TT from IDA. Aysel Vehapoglu, Gamze Ozgurhan, Ayşegul Dogan Demir, Selcuk Uzuner, Mustafa Atilla Nursoy, Serdar Turkmen, and Arzu Kacan Copyright © 2014 Aysel Vehapoglu et al. All rights reserved. Trace Element Status (Iron, Zinc, Copper, Chromium, Cobalt, and Nickel) in Iron-Deficiency Anaemia of Children under 3 Years Wed, 26 Feb 2014 12:27:47 +0000 Aim. To determine trace element status and aetiologic factors for development of trace elements deficiencies in children with iron-deficiency anaemia (IDA) aged 0 to 3 years. Contingent and Methods. 30 patients of the University Hospital, Pleven, Bulgaria—I group; 48 patients of the Sumy Regional Child’s Clinical Hospital, Sumy, Ukraine—II group; 25 healthy controls were investigated. Serum concentrations of iron, zinc, copper, chromium, cobalt, and nickel were determined spectrophotometrically and by atomic absorption spectrophotometry. Results. Because the obtained serum levels of zinc, copper, and chromium were near the lower reference limits, I group was divided into IA and IB. In IA group, serum concentrations were lower than the reference values for 47%, 57%, and 73% of patients, respectively. In IB group, these were within the reference values. In II group, results for zinc, cobalt, and nickel were significantly lower (), and results for copper were significantly higher in comparison to controls. Conclusion. Low serum concentrations of zinc, copper, cobalt, and nickel were mainly due to inadequate dietary intake, malabsorption, and micronutrient interactions in both studied groups. Increased serum copper in II group was probably due to metabolic changes resulting from adaptations in IDA. Data can be used for developing a diagnostic algorithm for IDA. Maria Georgieva Angelova, Tsvetelina Valentinova Petkova-Marinova, Maksym Vladimirovich Pogorielov, Andrii Nikolaevich Loboda, Vania Nedkova Nedkova-Kolarova, and Atanaska Naumova Bozhinova Copyright © 2014 Maria Georgieva Angelova et al. All rights reserved. An Etiologic Profile of Anemia in 405 Geriatric Patients Sun, 23 Feb 2014 09:24:01 +0000 Background. Anemia is a common condition in the elderly and a significant risk factor for increased morbidity and mortality, reducing not only functional capacity and mobility but also quality of life. Currently, few data are available regarding anemia in hospitalized geriatric patients. Our retrospective study investigated epidemiology and causes of anemia in 405 hospitalized geriatric patients. Methods. Data analysis was performed using laboratory parameters determined during routine hospital admission procedures (hemoglobin, ferritin, transferrin saturation, C-reactive protein, vitamin B12, folic acid, and creatinine) in addition to medical history and demographics. Results. Anemia affected approximately two-thirds of subjects. Of 386 patients with recorded hemoglobin values, 66.3% were anemic according to WHO criteria, mostly (85.1%) in a mild form. Anemia was primarily due to iron deficiency (65%), frequently due to underlying chronic infection (62.1%), or of mixed etiology involving a combination of chronic disease and iron deficiency, with absolute iron deficiency playing a comparatively minor role. Conclusion. Greater awareness of anemia in the elderly is warranted due to its high prevalence and negative effect on outcomes, hospitalization duration, and mortality. Geriatric patients should be routinely screened for anemia and etiological causes of anemia individually assessed to allow timely initiation of appropriate therapy. Tabea Geisel, Julia Martin, Bettina Schulze, Roland Schaefer, Matthias Bach, Garth Virgin, and Jürgen Stein Copyright © 2014 Tabea Geisel et al. All rights reserved.