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The Patient with Anemia and Iron Deficiency
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Haye H. van der Wal, Peter van der Meer
Both anemia and iron deficiency are common comorbidities in HF patients and are associated with substantial burdens to patients. The etiology of both comorbidities is related to the systemic consequences of HF (chronic inflammation, renal dysfunction, fluid retention, and malnutrition). Given the neutral effects of ESA therapy on prognosis and its safety concerns (increased risk of thromboembolism and stroke), treatment of anemia in HF patients using ESAs is not recommended. Instead, management of anemia should be focused on identifying the underlying cause, which should be treated, if possible. These include hematinic deficiencies (iron, vitamin B12, and folic acid) and gastrointestinal bleeding. In symptomatic patients with HFrEF and iron deficiency, intravenous iron should be considered to improve symptoms, quality of life, and exercise tolerance, irrespective of anemia. Long-term safety and efficacy characteristics of intravenous iron in HF are currently unknown, although ongoing randomized, clinical trials will evaluate its effects on cardiovascular morbidity and mortality. Currently, little is known about the etiology and clinical consequences of anemia and iron deficiency in HFpEF, a form of HF characterized by the greatest incidence of comorbidities. Whether treatment of anemia and iron deficiency in HFpEF is beneficial still needs to be determined.
Neurology
Published in Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva, Medical and Surgical Emergencies for Students and Junior Doctors, 2021
Faye Hill, Sash Noor, Neel Sharma
Investigations of choice are extensive and include a full blood count, urea and electrolytes, liver and thyroid function tests as well as a CRP. Urine should be screened to exclude infection and drug misuse. Haematinic screening should be performed as well. Imaging via computed tomography or MRI is beneficial in addition to an electroencephalogram. If an underlying cause is unclear, one can consider the use of a lumbar puncture.
Renal disease
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
A full blood count and liver function tests should also be checked regularly. Anaemia is common and haematinics should be prescribed. Maternal hypocalcaemia and hypercalcaemia are both potential problems, and calcium status should be carefully monitored. Doses of calcium and vitamin D may need to be altered in pregnancy.
Comparative analysis of the oral microbiome of burning mouth syndrome patients
Published in Journal of Oral Microbiology, 2022
Byeong-Min Lee, Ji Woon Park, Jung Hwan Jo, Bumjo Oh, Gehoon Chung
Clinical examinations included thorough medical history taking based on structured questionnaires and systemic interviewing and oral examination including visual inspection and palpation of the oral mucosa and teeth to identify abnormalities such as change in color and shape reflecting active inflammation. Psychological evaluation was done with Symptom Checklist-90-Revised (SCL-90-R) [31]. Laboratory examinations were done to rule out possible systemic factors that are known to be related to abnormal oral sensations including pain. Tests included complete blood counts with white blood cell differential, hematinic-related components such as iron, ferritin, vitamin B12, and folate. Blood glucose, liver function tests (total protein, albumin, total bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and cholesterol), kidney function tests (blood urea nitrogen and creatinine), and thyroid function tests [T3 (triiodothyronine), free T4 (thyroxine), and TSH (thyroid-stimulating hormone)] were done along with calcium, phosphorus, magnesium, and zinc level analysis.
An evaluation of ferric derisomaltose as a treatment for anemia
Published in Expert Review of Hematology, 2021
Xenophon Kassianides, Richard Bodington, Sunil Bhandari
The PROFOUND Trial randomized 350 patients on chemotherapy with non-hematological malignancies to receive either FDI or OI [56]. The study primarily assessed hematological response as a non-inferiority outcome and monitored safety and impact on quality of life. Hemoglobin increased significantly in both groups within 4 weeks, with non-inferiority displayed by FDI. There was a significantly improved hematinic response in the FDI group with increased TSAT and SF when compared to OI at week 1 (p = 0.003) and throughout the study (p < 0.001 at all-time points). This was potentially reflected in the significantly decreased fatigue score 12 weeks following FDI infusion (p < 0.001) [56]. A feasibility trial in patients on palliative chemotherapy with esophageal adenocarcinoma, compared single infusion of FDI to standard of care, defined as anemia managed through best traditional regimens available as decided by the clinical oncology team of the institution [57]. No significant difference in Hb concentration or the need for transfusion was demonstrated but a significantly raised SF between recruitment and end of first cycle of chemotherapy was noted with FDI (FDI: 770 µg/l, standard care: 116 µg/l; p < 0.05) alongside an improved quality of life. This study was terminated early due to poor recruitment but nonetheless demonstrated the need for larger trials in this topic [57].
Biochemical, hematological, and hormonal profile of rats orally administered methanol stem bark extract of Napoleona vogelii Hook and Planch (Lecythidaceae)
Published in Drug and Chemical Toxicology, 2019
Victor Olabowale Ikumawoyi, Esther Oluwatoyin Agbaje, Olufunsho Awodele, Akinwumi Akinyinka Akinyede
N. vogelii did not elicit toxic effects on hematological parameters in male and female rats on subchronic treatment. The evaluations of hematological indices are employed in the assessment of the toxic potential of plant extracts in man and animals (Sunmonu and Oloyede 2010). Changes in these parameters are very relevant to risk evaluation because they have higher predictive value for human toxicity when data are extrapolated from studies in rodents (Olson et al. 2000) to humans. For the male and female rats, there were nonsignificant increases in WBC count, lymphocytes, MCH, and MCHC on administration of the extract at 200 and 400 mg/kg respectively compared to control. This suggests an immunostimulating and hematinic effect of the extract. Lymphocytes are the main effector cells of the immune system and the observed increase elicited by the extract may be adduced to its ability to stimulate neutrophils to promote phagocytosis (McKnight et al. 1999).