Determination of serum soluble transferrin receptor (sTfR) has been proposed to identify iron-deficiency anemia (IDA) in patients affected by concurrent inflammatory disease that may spuriously increase ferritin concentration. The aim of this study was to critically review the available literature to assess the diagnostic efficacy of sTfR in complicated anemia. The criteria for study selection were: enrolment of patients with complicated anemia; bone marrow examination used as diagnostic gold standard for IDA; evaluation of sTfR vs. ferritin and binary data presentation. Six published studies met the criteria. However, the small size and wide heterogeneity of the studies did not allow us to conduct a meta-analysis. sTfR was overall more sensitive, even though it was evident that the ferritin sensitivity was influenced by selected cut-offs. Well-designed studies are still needed to define the added value, if any, of sTfR to ferritin for IDA detection in complicated anemia.

Se estudiaron 22 pacientes con anemia drepanocítica (AD) atendidos en el Instituto de Hematología e Inmunología (IHI), 12 del sexo femenino y 10 del masculino. El promedio de edad fue de 23 años (rango de 17 a 35) y de 25,7 años (rango de 17 a 43) respectivamente. Se establecieron 2 grupos de estudio: uno que incluyó pacientes en condiciones basales y otros con enfermos que tenían intensificación de la ictericia. A todos los pacientes se les hizo historia clínica completa y se les realizaron las siguientes investigaciones: hemoglobina, reticulocitos, prueba de Coombs, antígeno de superficie del virus de la hepatitis B (AgSHB), transaminasa glutámico-pirúvica (TGP), fosfatasa alcalina sérica (FAS), bilirrubina total y directa (BT, BD), examen microscópico de heces fecales, ultrasonido abdominal (UA), colecistografía oral (CO), drenaje biliar (DB), estudio radiográfico de abdomen simple, esófago, estómago y duodeno y la prueba de la secretina y pancreozimina. La tomografía axial computadorizada se realizó en 8 casos. En ningún enfermo pudo demostrarse la presencia de factores extrapancreáticos causantes de pancreatitis

RECORD STATUS:

This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database.

CITATION:

Queiro Verdes T. Cribado neonatal de la anemia falciforme. [Neonatal screening of sickle cell anemia] Santiago de Compostela: Galician Agency for Health Technology Assessment (AVALIA-T). Informes de evaluación de tecnologías sanitarias. 2013

Many conditions that would not be considered normal in a younger population are routinely accepted in older people as a part of so-called "normal" aging. Among these conditions are many chronic and debilitating conditions such as chronic pain, insomnia, weakness, fatigue, and anemia. This article reviews current evidence regarding the relationships among age, fatigue, weakness, anemia, and erythropoiesis. Anemia in the elderly is important because it can lead to weakness, fatigue, limitations in activity, and may increase cardiovascular risk. Recent studies of the effect of erythropoietin in an aging population support the hypothesis that anemia is associated with pathologic factors and not with normal aging. While older individuals admitted to hospitals are more likely to be anemic, these same individuals have a bone marrow mass and numbers of cultured progenitor cells that are similar to that of the younger population; therefore, the predicted response to erythropoietin, and thus the function of the bone marrow and cellular progenitors, is maintained. Thus, we can conclude that anemia is a correctable pathologic finding in elderly people. A number of studies have shown a strong relationship between fatigue and anemia, but few studies investigate to what degree age is a factor in weakness and fatigue. In a study of 375 anemic cancer patients with a median age of 61 years, age as a covariate in multiple linear regression analysis failed to reach significance for most measures of function and quality of life (QOL), including measures of energy, activities, mental health, general cancer-related QOL, and overall QOL. Additional analysis suggests that other factors, including cancer progression, hemoglobin change, and baseline hemoglobin levels, are much more important in determining change in functional and quality-of-life scores. In another set of 2,000 cancer patients and 1,000 controls, cancer patients experienced significantly more fatigue compared with controls. There was no correlation between cancer patient age and fatigue, while in controls the cohort aged 65 or more reported more fatigue than did younger subjects. Finally, measurement of QOL in the general population demonstrated, for both the Short-Form 36 and Functional Assessment of Cancer Therapy - Anemia questionnaires, that age alone is not significantly correlated with QOL. We suggest that chronic conditions such as fatigue and anemia are no more "normal" in an aging population than in a general population, and that all patients with chronic conditions be adequately treated and counseled for their condition.

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Introduction: Anemia is one of the most common medical complications to be encountered in critically ill patients. Based on the results of clinical trials, transfusion practices across the world have generally become more restrictive. However, because reduced oxygen delivery contributes to 'secondary' cerebral injury, anemia may not be as well tolerated among neurocritical care patients. Methods: The first portion of this paper is a narrative review of the physiologic implications of anemia, hemodilution, and transfusion in the setting of brain-injury and stroke. The second portion is a systematic review to identify studies assessing the association between anemia or the use of red blood cell transfusions and relevant clinical outcomes in various neurocritical care populations. Results: There have been no randomized controlled trials that have adequately assessed optimal transfusion thresholds specifically among brain-injured patients. The importance of ischemia and the implications of anemia are not necessarily the same for all neurocritical care conditions. Nevertheless, there exists an extensive body of experimental work, as well as human observational and physiologic studies, which have advanced knowledge in this area and provide some guidance to clinicians. Lower hemoglobin concentrations are consistently associated with worse physiologic parameters and clinical outcomes; however, this relationship may not be altered by more aggressive use of red blood cell transfusions. Conclusions: Although hemoglobin concentrations as low as7 g/dl are well tolerated in most critical care patients, such a severe degree of anemia could be harmful in brain-injured patients. Randomized controlled trials of different transfusion thresholds, specifically in neurocritical care settings, are required. The impact of the duration of blood storage on the neurologic implications of transfusion also requires further investigation. © 2009 Kramer and Zygun; licensee BioMed Central Ltd.

Background: Anaemia is a global public health problem. Children under five years of age living in developing countries (mostly Africa and South-East Asia) are highly affected. Although the causes for anaemia are multifactorial, malaria has been linked to anaemia in children living in malaria-endemic areas. Administering intermittent preventive antimalarial treatment (IPT) to children might reduce anaemia, since it could protect children from new Plasmodium parasite infection (the parasites that cause malaria) and allow their haemoglobin levels to recover. Objectives: To assess the effect of IPT for children with anaemia living in malaria-endemic areas. Search methods: We searched the Cochrane Infectious Diseases Group Specialized Register, Cochrane Central of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE; EMBASE; and LILACS. We also searched the World Health Organization (WHO) International Clinical Trial Registry Platform and metaRegister of Controlled Trials (mRCT) for ongoing trials up to 4 December 2014. Selection criteria: Randomized controlled trials (RCTs) evaluating the effect of IPT on children with anaemia. Data collection and analysis: Two review authors independently extracted data and assessed risk of bias. We analysed data by conducting meta-analyses, stratifying data according to whether participants received iron supplements or not. We used GRADE to assess the quality of evidence. Main results: Six trials with 3847 participants met our inclusion criteria. Trials were conducted in areas of low malaria endemicity (three trials), and moderate to high endemicity (three trials). Four trials were in areas of seasonal malaria transmission. Iron was given to all children in two trials, and evaluated in a factorial design in a further two trials. IPT for children with anaemia probably has little or no effect on the proportion anaemic at 12 weeks follow-up (four trials, 2237 participants, (moderate quality evidence). IPT in anaemic children probably increases the mean change in haemoglobin levels from baseline to follow-up at 12 weeks on average by 0.32 g/dL (MD 0.32, 95% CI 0.19 to 0.45; four trials, 1672 participants, moderate quality evidence); and may improve haemoglobin levels at 12 weeks (MD 0.35, 95% CI 0.06 to 0.64; four trials, 1672 participants, low quality evidence). For both of these outcomes, subgroup analysis did not demonstrate a difference between children receiving iron and those that did not. IPT for children with anaemia probably has little or no effect on mortality or hospital admissions at six months (three trials, 3160 participants moderate quality evidence). Subgroup analysis did not show a difference between those children receiving iron supplements and those that did not. Authors' conclusions: Trials did show a small effect on average haemoglobin levels but this did not appear to translate into an effect on mortality and hospital admissions. Three of the six trials were conducted in low endemicity areas where transmission is low and thus any protective effect is likely to be modest. © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

OBJECTIVE:

To evaluate the association between organophosphorus pesticides and aplastic anemia, and provide scientific evidence for the primary prevention of aplastic anemia.

METHODS:

The published papers of case control studies on the association between organophosphorus pesticides and aplastic anemia from January 1990 to August 2014 were collected from Chinese BioMedical Literature Base (CBM), Chinese National Knowledge Infrastructure (CNKI), PubMed and EMBASE. The papers which met the inclusion criteria were evaluated. The pooled odds ratios (OR) and 95% confidence interval (CI) of organophosphorus pesticides were calculated with software Review Manager 5.0. Subgroup analysis were conducted for different population and different usage of organophosphorus pesticides.

RESULTS:

A total of 9 papers were selected, involving 5 833 subjects (1 404 cases and 4 429 controls). The results showed that organophosphorus pesticides could increase the risk of aplastic anemia (OR=1.97, 95% CI.: 1.60-2.44) . Subgroup analysis showed that Asian (OR=2.01, 95% CI.: 1.52-2.66) had higher risk of aplastic anemia than American or European (OR=1.93, 95% CI.: 1.39-2.67) . Using pure organophosphorus pesticides (OR=2.15, 95% CI.: 1.60-2.88) was more prone to cause aplastic anemia than using the mixture of organophosphorus pesticides (OR=1.82, 95% CI.: 1.34-2.47).

CONCLUSION:

The analysis indicated that organophosphorus pesticides might be a risk factor for aplastic anemia. Reducing organophosphorus pesticides exposure in daily life and industrial or agricultural production could prevent the incidence of aplastic anemia.

Introducción: la anemia es el trastorno nutricional más frecuente en el mundo, y debido a que en el embarazo existe una gran demanda de hierro, se constituye en un importante riesgo de desarrollar anemia ferropénica. La anemia es la alteración hematológica más diagnosticada durante la gestación, por lo que todas las gestantes están en riesgo de padecer anemia en el embarazo, siendo más frecuente en países subdesarrollados. Es referida como un proceso dilucional secundario al aumento del volumen plasmático que ocurre durante el embarazo. Estudios clínicos revelaron que la anemia en el embarazo se asocia con complicaciones en la madre, en el feto y el recién nacido, relacionándose con mayor morbimortalidad fetal y perinatal, de ahí la importancia de un adecuado control prenatal con la suplementación de hierro necesaria para proveer las crecientes demandas en esta de la mujer. Objetivo: conocer la fisiopatología y establecer los criterios de diagnóstico y tratamiento de las eventuales complicaciones de la anemia en las mujeres embarazadas, así como la evidencia que existe sobre la importancia de su tratamiento durante el control prenatal. Metodología: se realizó una búsqueda bibliográfica en las bases de datos electrónicas Pubmed, Ovid, Elsevier, Interscience, EBSCO, Scopus, SciELO. Resultados: se revisaron series de casos o descriptivos, todos los que mostraran un número estadísticamente significativo de pacientes. Conclusiones: la anemia en el embarazo es un síndrome frecuente, que con un adecuado control prenatal puede prevenirse, diagnosticarse y tratarse antes de que muestre complicaciones. Se hace necesario aumentar la cobertura de la atención prenatal en todas las embarazadas; y es obligatorio que el personal sanitario haga un adecuado control y una óptima prescripción del hierro profiláctico en este grupo poblacional...

BACKGROUND:

People living with end-stage kidney disease (ESKD) often develop anaemia. Erythropoiesis-simulating agents (ESAs) are often given to people living with ESKD to maintain haemoglobin at a level to minimise need for transfusion. However, about 5% to 10% of patients with ESKD exhibit resistance to ESAs, and observational studies have shown that patients requiring high doses of ESA are at increased risk of mortality.

OBJECTIVES:

This review aimed to study the effects of interventions for the treatment of ESA-resistant anaemia in people with ESKD.

SEARCH METHODS:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE for randomised controlled trials (RCT) that involved participants with ESKD on dialysis or who were pre-dialysis patients with chronic kidney disease (stage 5). Date of last search: April 2013.

SELECTION CRITERIA:

ESA resistance was defined as failure to achieve or maintain haemoglobin/haematocrit levels within the desired target range despite appropriate ESA doses (erythropoietin ≥ 450 U/kg/wk intravenously or ≥ 300 U/kg/wk subcutaneously; darbepoetin ≥ 1.5 µg/kg/wk) in people who were not nutritionally deficient, or who had haematological or bleeding disorders. Extended inclusion criteria for ESA hyporesponsive state were: erythropoietin dose ≥ 300 U/kg/wk and ≥ 150 U/kg/wk for intravenous administration; or ≥ 200 U/kg/wk and ≥ 100 U/kg/wk for subcutaneous administration; or darbepoetin dose ≥ 1.0 µg/kg/wk).

DATA COLLECTION AND ANALYSIS:

Two authors independently assessed study quality and extracted data. Statistical analyses were performed using a random effects model and results expressed as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI).

MAIN RESULTS:

Titles and abstracts of 521 records were screened, of which we reviewed 99 from the full text. Only two studies matched our inclusion criteria. One study compared intravenous vitamin C versus no study medication for six months in 42 ESKD patients on haemodialysis who required intravenous erythropoietin (dose ≥ 450 U/kg/wk). The other included study compared high-flux dialyser versus low-flux dialyser for six months in 48 haemodialysis patients who required subcutaneous erythropoietin (dose ≥ 200 U/kg/wk). Because interventions differed, data could not be combined for quantitative meta-analysis.

AUTHORS' CONCLUSIONS:

There was inadequate evidence identified to inform recommendation of any intervention to ameliorate ESA hyporesponsiveness. Adequately powered RCTs are required to establish the safety and efficacy of interventions to improve responsiveness to ESA therapy.