1
|
Gonzalez VB, Hanna I, Shah CC, Koul PB. Iron Deficiency Anemia Presenting as Ischemic Stroke in Pediatric Patient. Clin Pediatr (Phila) 2024; 63:1017-1020. [PMID: 37735889 DOI: 10.1177/00099228231199835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
- Vincent B Gonzalez
- Department of Pediatrics, University of Florida Health, Jacksonville, FL, USA
| | - Issa Hanna
- Division of Pediatric Emergency Medicine, University of Florida Health, Jacksonville, FL, USA
| | - Chetan C Shah
- Division of Pediatric Radiology, Nemours Children's Health, Jacksonville, FL, USA
| | - Pulin B Koul
- Pediatric Emergency Medicine, Wolfson Children's Hospital, Jacksonville, FL, USA
| |
Collapse
|
2
|
Yelton SEG, Flores S, Sun LR, Nelson-McMillan K, Loomba RS. Association Between Congenital Heart Disease and Stroke: Insights from a National Database. Pediatr Cardiol 2024; 45:1-7. [PMID: 37837542 DOI: 10.1007/s00246-023-03315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/26/2023] [Indexed: 10/16/2023]
Abstract
To delineate prevalence of stroke in the pediatric intensive care unit and to determine risk factors for stroke and association of stroke with mortality in patients with congenital heart disease. Retrospective cohort study. Patients admitted to pediatric intensive care units in the USA participating in the Pediatric Health Information System database from 2016 to 2021. Patients were categorized as those who experienced ischemic or hemorrhagic stroke and those with congenital heart disease. We performed univariate and multivariate logistic regressions to determine risk factors associated with stroke and then developed a predictive model for stroke development in patients with congenital heart disease. Of 426,029 admissions analyzed, 4237 (0.9%) patients experienced stroke and 1197 (1.4%) of 80,927 patients with congenital heart disease developed stroke (odds ratio 1.15, 95% confidence interval 1.06-1.24). Patients with congenital heart disease, younger age, extracorporeal membrane oxygenation, mechanical ventilation, and cardiac arrest were most strongly associated with increased risk of stroke. Stroke increased odds of mortality for patients with congenital heart disease (odds ratio 2.49, 95% confidence interval 2.08-2.98). A risk score greater than 0 was associated with a 33.3% risk of stroke for patients with congenital heart disease (negative predictive value of 99%, sensitivity 69%, specificity 63%). Children with congenital heart disease are at increased risk for developing stroke, which is associated with increased mortality. Early identification of the most vulnerable patients may enable providers to implement preventative measures or rapid treatment strategies to prevent neurologic morbidity.
Collapse
Affiliation(s)
- Sarah E Gardner Yelton
- Division of Cardiology, Advocate Children's Hospital, Oak Lawn, IL, USA.
- Division of Critical Care, University of Chicago Comer Children's Hospital, Chicago, IL, USA.
| | - Saul Flores
- Section of Critical Care Medicine and Cardiology, Texas Children's Hospital, House, TX, USA
- Department of Pediatrics, Baylor School of Medicine, Houston, TX, USA
| | - Lisa R Sun
- Division of Pediatric Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kristen Nelson-McMillan
- Division of Cardiology, Advocate Children's Hospital, Oak Lawn, IL, USA
- Division of Critical Care, University of Chicago Comer Children's Hospital, Chicago, IL, USA
| | - Rohit S Loomba
- Division of Cardiology, Advocate Children's Hospital, Oak Lawn, IL, USA
- Department of Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| |
Collapse
|
3
|
Apaza C, Cuna W, Brañez F, Passera R, Rodriguez C. Frequency of Gastrointestinal Parasites, Anemia, and Nutritional Status among Children from Different Geographical Regions of Bolivia. J Trop Med 2023; 2023:5020490. [PMID: 38107388 PMCID: PMC10725312 DOI: 10.1155/2023/5020490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
The study aimed to measure the frequency of occurrence of infections with helminths, protozoa, and risk factors of undernutrition and anemia among schoolchildren from the Bolivian highland (altiplano) and lowland (subtropical) rural regions, with a high frequency of gastrointestinal parasite infections. Cross-sectional data were collected from 790 children, 5-13 years old. Microscopic examination of stool using the Ritchie technique, hemoglobin testing using the HemoCue analyzer, and anthropometric measurements were performed. Over 60% and 20% of children were infected with protozoa and helminth parasites, respectively. Infections caused by pathogenic Hymenolepis nana (15.7-5.2%), Ascaris lumbricoides (41.9-28.5%), Giardia lamblia (30.1-11.2%), Entamoeba histolytica (5.7-0.7%), and nonpathogenic Entamoeba coli (48.9-16%), Blastocystis hominis (40.2-28.5%), Iodamoeba butschli (16.1-2.5%), Chilomastix mesnili (19.2-7.3%), and Entamoeba histolytica/dispar (7.4-5.5%) parasites, were more prevalent in the highlands than the lowlands. Single parasitic infections were more prevalent in the lowlands; polyparasitism of light or heavy intensity predominated in the highlands. A strongly increased risk of anemia and a low prevalence of wasting were determined in children in the highlands. A higher risk for stunting was associated with children of older age, and a low burden of intestinal helminths would prevent wasting in children of highlands. Infections with A. lumbricoides and G. lamblia pathogens in older children were not significant covariates for stunting. Environmental, nutritional, and parasitic factors may predispose to anemia in the highlands. A nutritional intervention and parasite control effort will substantially improve children´s health in the highlands.
Collapse
Affiliation(s)
- Ceilan Apaza
- Hospital Municipal de Chulumani, Chulumani, La Paz, Bolivia
| | - Washington Cuna
- Unidad de Inmunología Parasitaria, Facultad de Medicina, Universidad Mayor de San Andrés, La Paz, Bolivia
| | - Froilán Brañez
- Unidad de Laboratorio Clínico, Hospital de Caranavi, Caranavi, La Paz, Bolivia
| | - Roberto Passera
- University of Turin, Department of Medical Science, Division of Nuclear Medicine, Corso AM Digliotti 14, Turin 10126, Italy
| | - Celeste Rodriguez
- Unidad de Inmunología Parasitaria, Facultad de Medicina, Universidad Mayor de San Andrés, La Paz, Bolivia
| |
Collapse
|
4
|
Goraya JS. Mineralizing Lenticulostriate Vasculopathy: An Emerging Risk Factor for Basal Ganglia Stroke After Minor Head Trauma in Young Children. Pediatr Neurol 2023; 145:22-27. [PMID: 37257396 DOI: 10.1016/j.pediatrneurol.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 06/02/2023]
Abstract
Mineralizing lenticulostriate vasculopathy is a well-recognized risk factor for basal ganglia stroke after minor head trauma in infants and young children; it is diagnosed on head computed tomography by the presence of basal ganglia calcification, seen as punctate hyperdensities on axial and linear hyperdensities on reconstructed coronal and sagittal images. In children with anterior fontanel window, its presence is suggested by branching hyperechogenic stripes in the basal ganglia region on cranial ultrasound. Brain magnetic resonance imaging, including susceptibility-weighted sequences and brain magnetic resonance angiography, fail to detect calcification or vascular abnormalities. Although its etiology remains unknown, mineralizing lenticulostriate vasculopathy is considered to represent end-stage pathology of lenticulostriate vasculopathy, a neonatal radiographic condition detected during routine neonatal cranial ultrasonographic examination and represents nonspecific finding associated with a multitude of etiologies. The significance of mineralizing lenticulostriate vasculopathy lies in the fact that it has emerged as one of the most common risk factors for basal ganglia stroke in Indian children, accounting for one-fourth to one-half of all causes of stroke in some studies. The outcome of stroke in children with mineralizing lenticulostriate vasculopathy appears to be favorable with the majority achieving complete or nearly complete recovery of their motor functions. Stroke recurrence following repeat head trauma is seen in a small proportion of children despite aspirin treatment.
Collapse
Affiliation(s)
- Jatinder Singh Goraya
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
| |
Collapse
|
5
|
Cohen CT, Agrusa JE, Hui SKR, Teruya J, Powers JM. A preventable death: Fatal stroke due to severe iron deficiency anemia. Pediatr Blood Cancer 2023; 70:e30014. [PMID: 36152002 DOI: 10.1002/pbc.30014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 08/31/2022] [Accepted: 08/30/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Clay T Cohen
- Division of Hematology/Oncology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Jennifer E Agrusa
- Division of Hematology/Oncology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Shiu-Ki Rocky Hui
- Division of Transfusion Medicine & Coagulation, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - Jun Teruya
- Division of Transfusion Medicine & Coagulation, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - Jacquelyn M Powers
- Division of Hematology/Oncology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
6
|
Tan MA, Layug EJV, Singh BP, Parakh M. Diagnosis of Pediatric Stroke in Resource Limited Settings. Semin Pediatr Neurol 2022; 44:100997. [PMID: 36456040 DOI: 10.1016/j.spen.2022.100997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 10/14/2022]
Abstract
Global awareness of stroke as a significant cause of neurologic sequelae and death in children has increased over the years as more data in this field becomes available. However, most published literature on pediatric stroke have limited geographic representation. Data on childhood stroke from developing countries remains limited. Thus, this paper reviewed geographic/ethnic differences in pediatric stroke risk factors highlighting those reported in low- and middle-income countries, and proposes a childhood arterial ischemic stroke diagnostic algorithm for resource limited settings. Stroke risk factors include cardiac disorders, infectious diseases, cerebral arteriopathies, hematologic disorders, inflammatory diseases, thrombophilia and genetic conditions. Infection of the central nervous system particularly tuberculous meningitis, is a leading cause of pediatric arterial ischemic stroke in developing countries. Stroke should be considered in children with acute focal neurologic deficit especially in the presence of aforementioned risk factors. Cranial magnetic resonance imaging with angiography is the neuroimaging modality of choice but if unavailable, cranial computed tomography with angiography may be performed as an alternative. If both are not available, transcranial doppler together with neurologic exam may be used to screen children for arterial ischemic stroke. Etiological diagnosis follows with the aid of appropriate laboratory tests that are available in each level of care. International collaborative research on stroke risk factors that are prevalent in low and middle income countries will provide information for drafting of stroke care guidelines that are universal yet inclusive taking into consideration regional differences in available resources with the goal of reducing global stroke burden.
Collapse
Affiliation(s)
- Marilyn A Tan
- Division of Pediatric Neurology, Departments of Pediatrics and Neurosciences, University of the Philippines - Philippine General Hospital, Manila, Philippines.
| | - Elbert John V Layug
- Division of Pediatric Neurology, Departments of Pediatrics and Neurosciences, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | | | | |
Collapse
|
7
|
Li X, Li N, Zhao G, Wang X. Effect of iron supplementation on platelet count in adult patients with iron deficiency anemia. Platelets 2022; 33:1214-1219. [PMID: 36050842 DOI: 10.1080/09537104.2022.2091772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Iron deficiency anemia (IDA) affects more than 1.2 billion individuals globally. In addition to anemia, reactive thrombocytosis is also a common clinical hematological condition in patients with IDA. However, some case reports have described the thrombotic complications in association with IDA-induced thrombocytosis. Patients with a high risk of thrombosis need prompt identification and effective treatment to prevent thrombotic complications. While iron replacement treatment has been shown to decrease platelet count in this context, there is limited published evidence on how iron supplementation affects the thrombocytosis caused by IDA. We retrospectively examined the clinical records of 440 patients with IDA from an RCT completed from 1 January 2016, to 30 December 2017, and data obtained from this study was used for post hoc analysis to examine the effect of iron on platelet count in IDA-induced thrombocytosis.The mean ± standard deviation (SD) platelet counts of the 440 patients with IDA was 310.23 ± 98.72 × 109/L. With baseline platelet counts>450 × 109 /L as the cutoff for thrombocytosis, patients were divided into 2 groups: 36 (8.1%) in the IDA with thrombocytosis group (mean ± SD platelet count, 521.67 ± 73.85 × 109/L) and the remaining 404 in the IDA without thrombocytosis group (mean ± SD platelet count, 291.39 ± 76.11 × 109/L).Differences were found in baseline characteristics including white blood cell (WBC) count, hemoglobin (Hb) level, mean corpuscular volume (MCV), transferrin saturation (TSAT), serum iron (SI) level, and total iron-binding capacity (TIBC) between the two groups (P < .05). From baseline to 8 weeks of continuous iron supplementation treatment, the mean platelet counts in both groups were decreased at 2-week treatment intervals. And in the IDA with thrombocytosis group, half of the patients resolved thrombocytosis after 2 weeks of iron supplementation, and the counts of all patients with thrombocytosis decreased below 450 × 109 /L within 6 weeks.In conclusion, the rate of reactive thrombocytosis in patients with IDA was 8.1%. IDA patients with thrombocytosis showed more severe anemia, lower ferritin, and more advanced iron deficiency than those without thrombocytosis. Platelet counts of half of the patients with thrombocytosis reduced below cut off of 450 × 109/L for thrombocytosis after 2 weeks of treatment, and all patients resolved thrombocytosis after 6 weeks. Our study provided clinical evidence for more effective and individualized iron management in the future. IDA patients with thrombocytosis should take active iron treatment and increase follow-up frequency to prevent thrombotic events. For patients with persistent thrombocytosis, a concomitant clonal process should be considered.
Collapse
Affiliation(s)
- Xue Li
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Nanyi Li
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Guangjie Zhao
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoqin Wang
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China.,Health Management Center, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
8
|
Kalff H, Cario H, Holzhauer S. Iron deficiency anemia and thrombosis risk in children-revisiting an old hypothesis. Front Pediatr 2022; 10:926925. [PMID: 35979407 PMCID: PMC9376258 DOI: 10.3389/fped.2022.926925] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Iron deficiency anemia has a high prevalence in children and has repeatedly been implicated as a risk factor for arterial and venous thrombosis. As an effective therapy for iron deficiency anemia is available, understanding the association between this form of anemia and the potentially severe thrombosis phenotype is of major clinical interest. Recent findings shed light on pathophysiology of hypercoagulability resulting from iron-restricted erythropoiesis. Specifically, an animal model of induced iron deficiency allowed identifying multiple mechanisms, by which iron deficiency anemia results in increased thrombus formation and thrombus progression both in arterial and venous thrombosis. These findings complement and support conclusions derived from clinical data. The purpose of this mini review is to summarize current evidence on the association of iron deficiency anemia and thrombosis. We want to increase the awareness of iron deficiency as a risk factor for thrombosis in the pediatric population. We discuss how novel pathophysiological concepts can be translated into the clinical settings and suggest clinical studies on prevention and treatment strategies in high-risk patient groups.
Collapse
Affiliation(s)
- Hannah Kalff
- Department of Pediatric Hematology and Oncology, Charité University Medicine, Berlin, Germany
| | - Holger Cario
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Susanne Holzhauer
- Department of Pediatric Hematology and Oncology, Charité University Medicine, Berlin, Germany
| |
Collapse
|
9
|
Kandinata NN, Breehl L, Chhetri B, Paudel S. Stroke Secondary to Iron Deficiency Anemia: A Case Report. Cureus 2021; 13:e19526. [PMID: 34804746 PMCID: PMC8592313 DOI: 10.7759/cureus.19526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/26/2022] Open
Abstract
Cerebrovascular accident is the fifth leading cause of death in the United States, with about 795,000 cases reported to the Centers for Disease Control and Prevention (CDC) each year. Several risk calculators for the development of stroke have been developed throughout the years, but none included iron deficiency anemia (IDA). We therefore would like to highlight the case of a 34-year-old female with severe iron deficiency anemia secondary to menorrhagia who had an ischemic stroke. An extensive workup was done and was negative. Given its significant presence with other comorbidities and various proposed pathogenesis, we propose that iron deficiency anemia be considered as a stroke factor. Studies in optimal hemoglobin or iron levels in patients with stroke to lower comorbidities and predict prognosis may also be beneficial.
Collapse
Affiliation(s)
| | - Logen Breehl
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Bhaskar Chhetri
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Suresh Paudel
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| |
Collapse
|
10
|
Shree N, Kommalur A, M. L, Kariyappa M, Devadas S, Kumble D, Sajjan SV, Rangegowda RK, Patel AS. Acute Ischemic Stroke in a Young Child and Its Association with SARS-CoV-2 Infection. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1736601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractThe coronavirus disease 2019 (COVID-19) in children has been shown to have lower morbidity and mortality in children as compared with adults. The neurological complications related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly reported in children, yet the cerebrovascular complications are rare. We report a case of a toddler who presented with right-sided hemiparesis and motor aphasia, with an antecedent history suggestive of COVID-19 infection. The child tested negative on the nasopharyngeal swab for real-time reverse transcription-polymerase chain reaction (RT-PCR), but the serology for anti-SARS-CoV-2 IgG assay was positive. The neuroimaging showed an acute infarct in the left middle cerebral artery territory. A detailed evaluation for causes of childhood stroke was unrevealing, except for the presence of severe iron deficiency anemia (IDA). The child was diagnosed as acute ischemic stroke (AIS) most probably secondary to mild COVID-19 infection. The objective of this case report is to explain the possibility of AIS after a mild COVID-19 infection, complicated by the underlying severe IDA. Therefore, an association between COVID-19 and stroke in children needs to be emphasized and RT-PCR for SARS-CoV-2 as well as serological assay must be included in the workup of stroke in the young.
Collapse
Affiliation(s)
- Nivya Shree
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Anitha Kommalur
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Lakshmi M.
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Mallesh Kariyappa
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Sahana Devadas
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Dhanalakshmi Kumble
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Sushma Veeranna Sajjan
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Ravichandra Kothur Rangegowda
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Ashray Sudarshan Patel
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| |
Collapse
|
11
|
Initial Diagnostic Evaluation of the Child With Suspected Arterial Ischemic Stroke. Top Magn Reson Imaging 2021; 30:211-223. [PMID: 34613944 DOI: 10.1097/rmr.0000000000000276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ABSTRACT Numerous factors make the initial diagnostic evaluation of children with suspected arterial ischemic stroke (AIS) a relatively unsettling challenge, even for the experienced stroke specialist. The low frequency of pediatric AIS, diversity of unique age-oriented stroke phenotypes, and unconventional approaches required for diagnosis and treatment all contribute difficulty to the process. This review aims to outline important features that differentiate pediatric AIS from adult AIS and provide practical strategies that will assist the stroke specialist with diagnostic decision making in the initial phase of care.
Collapse
|
12
|
Dam MJB, Pedersen RK, Knudsen TA, Andersen M, Skov V, Kjaer L, Hasselbalch HC, Ottesen JT. Data-driven analysis of the kinetics of the JAK2V617F allele burden and blood cell counts during hydroxyurea treatment of patients with polycythemia vera, essential thrombocythemia, and primary myelofibrosis. Eur J Haematol 2021; 107:624-633. [PMID: 34411333 DOI: 10.1111/ejh.13700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hydroxyurea (HU) treatment of patients with essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF) (MPNs) normalizes elevated blood cell counts within weeks in the large majority of patients. Studies on the impact of HU upon the kinetics of the JAK2V617F allele burden, leukocyte, and platelet counts over time are scarce. PURPOSE Using data-driven analysis as a novel tool to model the kinetics of the JAK2V617F allele burden and blood cell counts over time during treatment with HU. MATERIAL AND METHODS Using serial measurements of JAK2V617F and correlation analysis of routine hematological values (the Hb-concentration, leukocyte count, platelet count, and lactic dehydrogenase), we present a detailed description and analysis of the kinetics of the JAK2V617F, leukocyte, and platelet counts and lactic dehydrogenase in 27 patients (PV = 18; ET = 7; PMF = 2), who were followed in the Danish randomized trial (DALIAH). To further analyze the JAK2V617F kinetics, we use a machine learning clustering algorithm to group the response patterns. RESULTS Response patterns were highly heterogeneous, with clustering resulting in 3 groups and 3 outliers. In the large majority of patients, HU treatment was initially associated with a modest decline in the JAK2V617F allele burden in concert with a decline in leukocyte and platelet counts. However, HU did not induce a sustained and continuous decrease in the JAK2V617F allele burden. CONCLUSION Using data-driven analysis of the JAK2V617F allele burden, leukocyte, and platelet kinetics during treatment with HU, we have shown that HU does not induce a sustained decrease in the JAK2V617F allele burden and neither induces sustained normalization of elevated cell counts in MPN patients. Our results may explain why MPN patients during treatment with HU still have a substantially increased risk of thrombosis.
Collapse
Affiliation(s)
- Marc J B Dam
- Center for Mathematical Modeling - Human Health and Disease, IMFUFA, Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Rasmus K Pedersen
- Center for Mathematical Modeling - Human Health and Disease, IMFUFA, Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Trine A Knudsen
- Department of Haematology, Zealand University Hospital, Roskilde, Denmark
| | - Morten Andersen
- Center for Mathematical Modeling - Human Health and Disease, IMFUFA, Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Vibe Skov
- Department of Haematology, Zealand University Hospital, Roskilde, Denmark
| | - Lasse Kjaer
- Department of Haematology, Zealand University Hospital, Roskilde, Denmark
| | - Hans C Hasselbalch
- Department of Haematology, Zealand University Hospital, Roskilde, Denmark
| | - Johnny T Ottesen
- Center for Mathematical Modeling - Human Health and Disease, IMFUFA, Department of Science and Environment, Roskilde University, Roskilde, Denmark
| |
Collapse
|
13
|
Goraya JS, Berry S, Kaur A, Singh G. Arterial Ischemic Stroke-Peculiarities of Clinical Presentation and Risk Factors in Indian Children. Neuropediatrics 2021; 52:294-301. [PMID: 34102685 DOI: 10.1055/s-0041-1728773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There are not enough recent studies on arterial ischemic stroke (AIS) in Indian children. We retrospectively reviewed data on 95 children (69 boys), aged 3 months to 17 years, with AIS. Focal signs were noted in 84 (88%) with hemiparesis in 72 (76%). Diffuse signs were present in 33 (35%) with fever in 22 (23%), altered mental status in 20 (21%), and headache in 12 (13%). Seizures occurred in 29 (31%) children. Arteriopathy was observed in 57 (60%) children with mineralizing lenticulostriate vasculopathy (mLSV) in 22 (23%) being the most common, followed by moyamoya in 14 (15%), arterial dissection in 9 (10%), and focal cerebral arteriopathy (FCA) in 8 (8%). Preceding head/neck trauma was present in 27 (28%) children: 23 had minor head trauma (MHT), 3 neck trauma, and 1 unspecified. Other common risk factors (RFs) were iron deficiency in 10 children, homocysteinemia in 8 children, and tuberculous meningitis in 5 children. Complete or nearly complete recovery occurred in 42 (44%). Nine children developed epilepsy and five cognitive and language disability. Stroke recurrences occurred in nine children. Overall, arteriopathies accounted for majority of the cases of childhood AIS in our study with mLSV and moyamoya being the most frequent. Compared with data from Western countries, FCAs, postvaricella arteriopathy, and arterial dissections were less common. Of the nonarteriopathic RFs, MHT, iron deficiency, homocysteinemia, and neuroinfections were most frequent in our cohort in contrast to cardioembolic diseases and inherited procoagulant conditions, which are common in developed countries.
Collapse
Affiliation(s)
- Jatinder Singh Goraya
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Shivankshi Berry
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Amandeep Kaur
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Gagandeep Singh
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| |
Collapse
|
14
|
Düzgün E, Demir N, Alkan AA, Uslu Doğan C, Çakır A. Retinochoroidal vascular plexuses in patients with iron deficiency anaemia. Clin Exp Optom 2021; 105:326-332. [PMID: 33938383 DOI: 10.1080/08164622.2021.1916387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Clinical relevance: Optical coherence tomography angiography (OCT-A) may enable the identification of alteration in the retinochoroidal microvasculature in patients with iron deficiency anaemia.Background: To investigate the presence of macular microvascular alterations in females with IDA by using OCT-A.Methods: This is a cross-sectional comparative study. Forty patients with IDA and 35 age-matched healthy women underwent a complete ophthalmologic examination and OCT-A imaging. Foveal avascular zone parameters and the vessel density in the superficial (SCP) and deep capillary plexus (DCP) were calculated using automated software. All measurements were compared between groups. Correlations between the OCT-A metrics and haematological laboratory parameters were evaluated.Results: Compared to healthy subjects, IDA patients revealed significantly decreased vessel density of the SCP in all parafoveal quadrants (p < 0.05). In contrast, vessel density analysis in DCP has shown no statistically significant difference in all parafoveal quadrants (p > 0.05). Although foveal vessel density in both SCP and DCP were higher in the IDA group, only the foveal vessel density in DCP was significantly higher than controls (p = 0.001). The mean values of the foveal avascular zone area and perimeter and choriocapillaris flow area were significantly lower in the IDA group (p < 0.05). The parafoveal vessel density in SCP, foveal avascular zone area, and choriocapillaris flow area were positively correlated with haematological parameters including haemoglobin, haematocrit, mean corpuscular haemoglobin, and mean corpuscular volume (p < 0.01).Conclusion: Patients with IDA had decreased parafoveal vessel density in the SCP, but not the DCP. Foveal avascular zone metrics and choriocapillaris flow area measurements were significantly lower in IDA.
Collapse
Affiliation(s)
- Eyüp Düzgün
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nazan Demir
- Department of Internal Medicine, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Abdurrahman Alpaslan Alkan
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ceylan Uslu Doğan
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Akın Çakır
- Department of Ophthalmology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
15
|
Takele WW, Baraki AG, Wolde HF, Desyibelew HD, Derseh BT, Dadi AF, Mekonnen EG, Akalu TY. Anemia and Contributing Factors in Severely Malnourished Infants and Children Aged between 0 and 59 Months Admitted to the Treatment Centers of the Amhara Region, Ethiopia: A Multicenter Chart Review Study. Anemia 2021; 2021:6636043. [PMID: 33854799 PMCID: PMC8019621 DOI: 10.1155/2021/6636043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/25/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Anemia among severely malnourished children is a double burden that could make the treatment outcome of severe acute malnutrition (SAM) more unfavorable. The burden and the factors are, however, uncovered among children in the Amhara region. Therefore, the study was aimed at determining the prevalence of anemia and identifying contributing factors in severely malnourished children aged between 0 and 59 months admitted to the treatment centers of the Amhara region referral hospitals. METHODS A facility-based cross-sectional study was conducted that included 1,301 infants and children, who developed SAM and were admitted to the three referral hospitals of the Amhara region. Data were extracted using a data extraction checklist. The binary logistic regression analysis was employed to show an association between the dependent and independent variables. Multicollinearity was assessed using the variance inflation factor (VIF) and no problem was detected (overall VIF = 1.67). The presence of association was declared based on the p-value (≤0.05), and the adjusted odds ratio with its respective 95% confidence interval was used to report the direction, as well as the strength of association. RESULTS About 41.43% (95% CI: 38.78%-44.13%) of severely malnourished infants and children have developed anemia, of which around half (47%) of them were under six months old. Rural residence (AOR = 1.56; 95% CI: 1.14-2.12) and HIV infection (AOR = 2.00; 95% CI: 1.04-3.86) were significantly associated with higher odds of anemia. Furthermore, being exclusively breastfed (AOR = 0.57; 95% CI 0.39-0.83) remarkably reduced the likelihood of anemia. CONCLUSIONS This data confirms that anemia among severely malnourished infants and children is a public health problem in the Amhara region. Infants younger than six months were at a higher risk of anemia. Being a rural resident and contracting HIV infection have elevated the occurrence of anemia, whereas being exclusively breastfed decreased the risk. Therefore, the study gives an insight to policymakers and planners to strengthen the existing exclusive breastfeeding practice. Strategies being practiced to prevent HIV transmission and early detection, as well as treatment, should also be strengthened. Furthermore, mothers/caretakers of infants and children residing in the rural areas deserve special attention through delivering nutrition education.
Collapse
Affiliation(s)
- Wubet Worku Takele
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adhanom Gebreegziabher Baraki
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hanna Demelash Desyibelew
- Department of Human Nutrition, College of Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Behailu Tariku Derseh
- Department of Public Health, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Abel Fekadu Dadi
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA 5001, Australia
| | - Eskedar Getie Mekonnen
- Departent of Reproductive and Child Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
16
|
Jimenez K, Leitner F, Leitner A, Scharbert G, Schwabl P, Kramer AM, Krnjic A, Friske J, Helbich T, Evstatiev R, Khare V, Gasche C. Iron deficiency-induced thrombocytosis increases thrombotic tendency in rats. Haematologica 2021; 106:782-794. [PMID: 32079699 PMCID: PMC7928018 DOI: 10.3324/haematol.2019.245092] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Indexed: 12/19/2022] Open
Abstract
Iron deficiency (ID) is globally prevalent, and apart from anemia is associated with thrombocytosis. While considered benign, studies linking thrombotic events with prior ID anemia suggest otherwise. In this study we used animal models to assess the influence of ID on thrombotic tendency. Sprague-Dawley rats were fed control or iron-deficient diets and ferric carboxymaltose was used to reverse ID. Thrombosis was induced by stenosis of the inferior vena cava or damage to the right carotid artery using ferric chloride. Thrombi were evaluated histologically and by high frequency ultrasound in the venous model. ID consistently induced thrombocytosis alongside anemia. The growth of venous thrombi and the final dimensions of both arterial and venous thrombi were greater in animals with ID. In both models, platelet numbers correlated with the final thrombus size, with thrombi in iron-deficient animals having the largest platelet areas. Platelet function was also evaluated in surgically-naïve rats. Coagulability, determined by thromboelasto - graphy, and hemostasis, evaluated by tail transection, were enhanced in the animals with ID. Platelet P-selectin expression and plasma P-selectin levels were both higher in animals with ID. Platelet adhesion and aggregation in ID was impaired under shear flow but was intact in static assays. Iron replacement therapy reversed all ID-related changes in hematologic parameters, thrombus dimensions, and platelet assays. In summary, ID alone increases thrombotic tendency. Iron replacement therapy reverses these changes, making it a viable strategy for the prevention of ID-related thrombotic disease. This may be of importance in patients with chronic illnesses who may already be at increased risk of thrombosis, such as those with inflammatory bowel disease, chronic kidney disease, or cancer.
Collapse
Affiliation(s)
- Kristine Jimenez
- Div. of Gastroenterology and Hepatology,Dept. of Internal Medicine III, Medical University of Vienna
| | - Florentina Leitner
- Div. of Gastroenterology and Hepatology,Dept. of Internal Medicine III, Medical University of Vienna
| | - Aran Leitner
- Div. of Gastroenterology and Hepatology,Dept. of Internal Medicine III, Medical University of Vienna
| | - Gisela Scharbert
- Department of Special Anaesthesiology and Pain Management, General Intensive Care and Pain Control
| | - Philipp Schwabl
- Div. of Gastroenterology and Hepatology,Dept. of Internal Medicine III, Medical University of Vienna
| | | | - Anita Krnjic
- Div. of Gastroenterology and Hepatology,Dept. of Internal Medicine III, Medical University of Vienna
| | - Joachim Friske
- Department of Biomedical Imaging and Image-guided Therapy, Division of Gender and Molecular Imaging
| | - Thomas Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Gender and Molecular Imaging
| | - Rayko Evstatiev
- Div. of Gastroenterology and Hepatology,Dept. of Internal Medicine III, Medical University of Vienna
| | - Vineeta Khare
- Div. of Gastroenterology and Hepatology,Dept. of Internal Medicine III, Medical University of Vienna
| | - Christoph Gasche
- Div. of Gastroenterology and Hepatology,Dept. of Internal Medicine III, Medical University of Vienna
| |
Collapse
|
17
|
Awad D, Kousa O, Essa A, Kuniyoshi J, Kousa H, Qasim A, Andukuri V, Kassim T. Acute ischemic stroke as initial manifestation of undiagnosed iron deficiency anemia: case-report and literature review. AME Case Rep 2020; 4:23. [PMID: 33178995 PMCID: PMC7608734 DOI: 10.21037/acr-20-72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/05/2020] [Indexed: 11/06/2022]
Abstract
Cerebrovascular disease is the second leading cause of death in the United States in adults aged 65 years and older and is most commonly caused by atherosclerosis. More so, cryptogenic strokes account for one-third of all ischemic strokes. At the same time, iron deficiency anemia is prevalent worldwide and mostly affects females of childbearing age. Here we report a case of a 42-year-old female who presented with symptoms of acute ischemic stroke and was found to have severe iron deficiency anemia. After prompt investigation of other secondary causes, it was determined that her stroke was likely secondary to her iron deficiency anemia. Upon review of the literature, a few case reports showed an association between iron deficiency anemia and strokes in the adult population, but little evidence exists supporting a direct relationship between the two entities. In this case, we aim to evaluate the complex relationship between iron deficiency anemia and stroke and to define a new potential cause of ischemic stroke, which would have been considered earlier as cryptogenic. However, further studies in the future are warranted to validate our observation.
Collapse
Affiliation(s)
- Dana Awad
- Internal Medicine Residency, Creighton University, Omaha, NE, USA
| | - Omar Kousa
- Internal Medicine Residency, Creighton University, Omaha, NE, USA
| | - Amr Essa
- Internal Medicine Residency, Creighton University, Omaha, NE, USA
| | | | - Hamza Kousa
- Medical Student, University of Sharjah, Sharjah, United Arab Emirates
| | - Abdallah Qasim
- Internal Medicine Residency, Creighton University, Omaha, NE, USA
| | | | - Thamer Kassim
- Internal Medicine, Creighton University, Omaha, NE, USA
| |
Collapse
|
18
|
Song AB, Kuter DJ, Al-Samkari H. Characterization of the rate, predictors, and thrombotic complications of thrombocytosis in iron deficiency anemia. Am J Hematol 2020; 95:1180-1186. [PMID: 32619079 DOI: 10.1002/ajh.25925] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/16/2022]
Abstract
The association of thrombocytosis with iron deficiency anemia (IDA) is well-recognized, but data describing the rate, predictors, and risk of thrombotic complications associated with IDA-related thrombocytosis are limited. We queried an institutional patient data repository containing comprehensive chart data for over 6 million patients to identify IDA patients with and without thrombocytosis and thrombotic events over a 40-year time period (1979 to 2019). Demographics, hematological parameters, thrombosis history, and other medical history were collected. Fidelity of query data was assessed via detailed manual chart review of 700 patients, including confirmation of ferritin and hematologic parameters in addition to temporal and clinical association of thrombocytosis. Our queries identified 36 327 cases of IDA of which 15 022 had thrombocytosis. Following assessment for data integrity, we observed a thrombocytosis rate of 32.6% in patients with IDA. The rate of thrombosis was calculated to be 7.8% in patients with IDA and 15.8% in patients with IDA and thrombocytosis. Platelet mass index at time of peak thrombocytosis was significantly higher than at baseline and was strongly negatively correlated with hemoglobin at peak thrombocytosis. A multivariable model demonstrated a significant predictive relationship between decreasing hemoglobin and increasing platelet count at peak thrombocytosis. In conclusion, we observed reactive thrombocytosis in one-third of IDA patients, and a 2-fold thrombosis risk in patients with IDA and thrombocytosis compared with patients with IDA alone. Given the global burden of untreated and undertreated IDA, adequate IDA treatment may reduce thrombotic complications and associated morbidity and mortality.
Collapse
Affiliation(s)
- Andrew B Song
- Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David J Kuter
- Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hanny Al-Samkari
- Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
19
|
Farias-Moeller R, Siddiqui S, Orr M, Mondok L. Too Much of a Good Thing? Cerebral Sinovenous Thrombosis Due to Excessive Milk Intake Associated Anemia. J Child Neurol 2020; 35:585-590. [PMID: 32429785 DOI: 10.1177/0883073820923807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In young children, excessive cow's milk intake causes iron-deficiency anemia, which is associated with hypercoagulable states. We present a case series of 4 toddlers with excessive milk intake iron-deficiency anemia and cerebral sinovenous thrombosis. METHODS Retrospective chart review of 4 patients was performed for patients with cerebral sinovenous thrombosis and iron-deficiency anemia secondary to excessive milk intake. Iron-deficiency anemia was defined as hemoglobin <11 mg/dL, mean corpuscular volume <70 fL, and serum ferritin <12 μg/L. Excessive milk intake was defined as consumption of >24 oz daily. Clinical, laboratory, and radiographic features were reviewed. RESULTS Age ranged from 12 to 24 months. Average hemoglobin, hematocrit, mean corpuscular volume, and ferritin levels were 6.1 g/dL, 22.7 g/dL, 52.7 fL, and 3.2 ng/mL, respectively. Daily milk consumption ranged from 40 to 60 oz. All patients presented with focal neurologic deficits, including seizures in 3. The location of cerebral sinovenous thrombosis varied, and 3 patients had venous infarcts, one of them hemorrhagic. All patients had a limited diet and were described as "picky eaters" by their parents, and only 1 had transitioned of a bottle. All patients were treated with anticoagulation, iron supplementation, and extensive dietary counseling to reduce cow's milk intake. CONCLUSION Iron-deficiency anemia due to excessive milk intake is an important and preventable etiology of pediatric cerebral sinovenous thrombosis. Focused anticipatory guidance is necessary for at-risk groups to prevent this neurologic emergency.
Collapse
Affiliation(s)
- Raquel Farias-Moeller
- Division of Child Neurology, Department of Neurology, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, USA.,Division of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, USA
| | - Sara Siddiqui
- Division of Child Neurology, Department of Neurology, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, USA
| | - Megan Orr
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lileth Mondok
- Division of Child Neurology, Department of Neurology, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
20
|
Quiros Roldan E, Biasiotto G, Magro P, Zanella I. The possible mechanisms of action of 4-aminoquinolines (chloroquine/hydroxychloroquine) against Sars-Cov-2 infection (COVID-19): A role for iron homeostasis? Pharmacol Res 2020; 158:104904. [PMID: 32430286 PMCID: PMC7217799 DOI: 10.1016/j.phrs.2020.104904] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 02/06/2023]
Abstract
The anti-malarial drugs chloroquine (CQ) and primarily the less toxic hydroxychloroquine (HCQ) are currently used to treat autoimmune diseases for their immunomodulatory and anti-thrombotic properties. They have also been proposed for the treatment of several viral infections, due to their anti-viral effects in cell cultures and animal models, and, currently, for the treatment of coronavirus disease 2019 (COVID-19), the pandemic severe acute respiratory syndrome caused by coronavirus 2 (Sars-Cov-2) infection that is spreading all over the world. Although in some recent studies a clinical improvement in COVID-19 patients has been observed, the clinical efficacy of CQ and HCQ in COVID-19 has yet to be proven with randomized controlled studies, many of which are currently ongoing, also considering pharmacokinetics, optimal dosing regimen, therapeutic level and duration of treatment and taking into account patients with different severity degrees of disease. Here we review what is currently known on the mechanisms of action of CQ and HCQ as anti-viral, anti-inflammatory and anti-thrombotic drugs and discuss the up-to-date experimental evidence on the potential mechanisms of action of CQ/HCQ in Sars-Cov2 infection and the current clinical knowledge on their efficacy in the treatment of COVID-19 patients. Given the role of iron in several human viral infections, we also propose a different insight into a number of CQ and HCQ pharmacological effects, suggesting a potential involvement of iron homeostasis in Sars-Cov-2 infection and COVID-19 clinical course.
Collapse
Affiliation(s)
- Eugenia Quiros Roldan
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Giorgio Biasiotto
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; Clinical Chemistry Laboratory, Cytogenetics and Molecular Genetics Section, Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Paola Magro
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Isabella Zanella
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; Clinical Chemistry Laboratory, Cytogenetics and Molecular Genetics Section, Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy.
| |
Collapse
|
21
|
Medley TL, Miteff C, Andrews I, Ware T, Cheung M, Monagle P, Mandelstam S, Wray A, Pridmore C, Troedson C, Dale RC, Fahey M, Sinclair A, Walsh P, Stojanovski B, Mackay MT. Australian Clinical Consensus Guideline: The diagnosis and acute management of childhood stroke. Int J Stroke 2018; 14:94-106. [DOI: 10.1177/1747493018799958] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke is among the top 10 causes of death in children and survivors carry resulting disabilities for decades, at substantial cost to themselves and their families. Children are not currently able to access reperfusion therapies, due to limited evidence supporting safety and efficacy and long diagnostic delays. The Australian Clinical Consensus Guideline for the Diagnosis and Acute Management of Childhood Stroke was developed to minimize unwarranted variations in care and document best evidence on the risk factors, etiologies, and conditions mimicking stroke that differ from adults. Clinical questions were formulated to inform systematic database searches from 2007 to 2017, limited to English and pediatric studies. SIGN methodology and the National Health and Medical Research Council system were used to screen and classify the evidence. The Grades of Recommendation, Assessment, Development, and Evaluation system (GRADE) was used to grade evidence as strong or weak. The Guideline provides more than 60 evidence-based recommendations to assist prehospital and acute care clinicians in the rapid identification of childhood stroke, choice of initial investigation, to confirm diagnosis, determine etiology, selection of the most appropriate interventions to salvage brain at risk, and prevent recurrence. Recommendations include advice regarding the management of intracranial pressure and congenital heart disease. Implementation of the Guideline will require reorganization of prehospital and emergency care systems, including the development of regional stroke networks, pediatric Code Stroke, rapid magnetic resonance imaging and accreditation of primary pediatric stroke centers with the capacity to offer reperfusion therapies. The Guideline will allow auditing to benchmark timelines of care, access to acute interventions, and outcomes. It will also facilitate the development of an Australian childhood stroke registry, with data linkage to international registries, to allow for accurate data collection on stroke incidence, treatment, and outcomes.
Collapse
Affiliation(s)
- Tanya L Medley
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
- Department of Paediatrics University of Melbourne, Melbourne, Australia
| | | | - Ian Andrews
- Sydney Children's Hospital, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Tyson Ware
- Royal Hobart Hospital, Hobart, Australia
| | - Michael Cheung
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
- Department of Paediatrics University of Melbourne, Melbourne, Australia
- Department of Cardiology Royal Children's Hospital, Melbourne, Australia
| | - Paul Monagle
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
- Department of Paediatrics University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
| | - Simone Mandelstam
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
- Department of Paediatrics University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
| | - Alison Wray
- Department of Paediatrics University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
| | | | - Christopher Troedson
- Children's Hospital at Westmead, Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - Russell C Dale
- Children's Hospital at Westmead and University of Sydney, Sydney Australia
| | - Michael Fahey
- Department of Paediatrics Monash University, Department of Medicine Melbourne University, and Monash Children's Hospital, Melbourne, Australia
| | - Adriane Sinclair
- Lady Cilento Children's Hospital, University of Queensland, Brisbane, Australia
| | | | - Belinda Stojanovski
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
| | - Mark T Mackay
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
- Department of Paediatrics University of Melbourne, Melbourne, Australia
- Department of Neurology Royal Children's Hospital, Melbourne Australia
| |
Collapse
|
22
|
Özdemir ZC, Düzenli Kar Y, Gündüz E, Turhan AB, Bör Ö. Evaluation of hypercoagulability with rotational thromboelastometry in children with iron deficiency anemia. Hematology 2018; 23:664-668. [DOI: 10.1080/10245332.2018.1452456] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Zeynep Canan Özdemir
- Department of Pediatric Hematology/Oncology, Eskişehir Osmangazi University Faculty of Medicine, Ekişehir, Turkey
| | - Yeter Düzenli Kar
- Department of Pediatric Hematology/Oncology, Eskişehir Osmangazi University Faculty of Medicine, Ekişehir, Turkey
| | - Eren Gündüz
- Department of Hematology, Eskişehir Osmangazi University Faculty of Medicine, Ekişehir, Turkey
| | - Ayşe Bozkurt Turhan
- Department of Pediatric Hematology/Oncology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Özcan Bör
- Department of Pediatric Hematology/Oncology, Eskişehir Osmangazi University Faculty of Medicine, Ekişehir, Turkey
| |
Collapse
|
23
|
Mackay MT, Monagle P, Babl FE. Improving diagnosis of childhood arterial ischaemic stroke. Expert Rev Neurother 2017; 17:1157-1165. [DOI: 10.1080/14737175.2017.1395699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mark T. Mackay
- Department of Neurology, Royal Children’s Hospital, Parkville, Australia
- Clinical Sciences Theme, Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Florey Institute of Neurosciences and Mental Health, Parkville, Australia
| | - Paul Monagle
- Clinical Sciences Theme, Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of Haematology, Royal Children’s Hospital, Parkville, Australia
| | - Franz E. Babl
- Clinical Sciences Theme, Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Emergency Department, Royal Children’s Hospital Melbourne, Parkville, Australia
| |
Collapse
|
24
|
Prevalence of cancer in Takotsubo cardiomyopathy: Short and long-term outcome. Int J Cardiol 2017; 238:159-165. [DOI: 10.1016/j.ijcard.2017.02.093] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 02/06/2017] [Accepted: 02/20/2017] [Indexed: 12/19/2022]
|
25
|
Kaiafa G, Savopoulos C, Kanellos I, Mylonas KS, Tsikalakis G, Tegos T, Kakaletsis N, Hatzitolios AI. Anemia and stroke: Where do we stand? Acta Neurol Scand 2017; 135:596-602. [PMID: 27480069 DOI: 10.1111/ane.12657] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 02/03/2023]
Abstract
Anemia seems to have a clear relationship with cerebrovascular events (CVEs), as there is a direct connection between central nervous system, blood supply, and tissue oxygen delivery. Anemia is considered a hyperkinetic state which disturbs endothelial adhesion molecule genes that may lead to thrombus formation. Furthermore, blood flow augmentation and turbulence may result in the migration of this thrombus, thus producing artery-to-artery embolism. It is for this reason that anemia is characterized as "the fifth cardiovascular risk factor." Anemia is consistently present in patients with acute stroke, ranging from 15% to 29%, while the mortality rate was significantly higher in patients suffering from anemia at the time of admission. Different types of anemia (sickle cell disease, beta thalassemia, iron deficiency anemia [IDA]) have been associated with increased cardiovascular and CVE risk. The relation between hemoglobin level and stroke would require further investigation. Unfortunately, treatment of anemia in cardiovascular and cerebrovascular disease still lacks clear targets and specific therapy has not developed. However, packed red blood cell transfusion is generally reserved for therapy in patients with CVEs. What is more, treatment of IDA prevents thrombosis and the occurrence of stroke; although iron levels should be checked, chronic administration favors thrombosis. Regarding erythropoietin (EPO), as there is lack of studies in anemic stroke patients, it would be desirable to utilize both neuroprotective and hematopoietic properties of EPO in anemic stroke patients. This review aims to clarify the poorly investigated and defined issues concerning the relation of anemia and CVEs.
Collapse
Affiliation(s)
- G. Kaiafa
- First Propaedeutic Department of Internal Medicine; AHEPA University Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - C. Savopoulos
- First Propaedeutic Department of Internal Medicine; AHEPA University Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - I. Kanellos
- First Propaedeutic Department of Internal Medicine; AHEPA University Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - K. S. Mylonas
- First Propaedeutic Department of Internal Medicine; AHEPA University Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - G. Tsikalakis
- First Propaedeutic Department of Internal Medicine; AHEPA University Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - T. Tegos
- First Department of Neurology; AHEPA University Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - N. Kakaletsis
- First Propaedeutic Department of Internal Medicine; AHEPA University Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
- First Department of Neurology; AHEPA University Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - A. I. Hatzitolios
- First Propaedeutic Department of Internal Medicine; AHEPA University Hospital; Aristotle University of Thessaloniki; Thessaloniki Greece
| |
Collapse
|
26
|
Dowling MM, Kirkham FJ. Stroke in sickle cell anaemia is more than stenosis and thrombosis: the role of anaemia and hyperemia in ischaemia. Br J Haematol 2016; 176:151-153. [PMID: 27858986 DOI: 10.1111/bjh.14422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michael M Dowling
- Departments of Pediatrics and Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Institute of Child Health, London, UK
| |
Collapse
|
27
|
[Iron deficiency, thrombocytosis and thromboembolism]. Wien Med Wochenschr 2016; 166:437-446. [PMID: 27682430 DOI: 10.1007/s10354-016-0514-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 08/05/2016] [Indexed: 12/16/2022]
Abstract
Iron deficiency, the most common nutritional deficiency worldwide, is often associated with reactive thrombocytosis. Although secondary thrombocytosis is commonly considered to be harmless, there is accumulating evidence that elevated platelet counts, especially in the setting of iron deficiency, can lead to an increased thromboembolic risk in both arterial and venous systems. Here we present the mechanisms of iron deficiency-induced thrombocytosis and summarize its clinical consequences especially in patients with inflammatory bowel diseases, chronic kidney disease or cancer. We hypothesize that iron deficiency is an underestimated thromboembolic risk factor, and that iron replacement therapy can become an effective preventive strategy in a variety of clinical settings.
Collapse
|
28
|
Increased Number and Distribution of Cerebral Microbleeds Is a Risk Factor for Cognitive Dysfunction in Hemodialysis Patients: A Longitudinal Study. Medicine (Baltimore) 2016; 95:e2974. [PMID: 27015171 PMCID: PMC4998366 DOI: 10.1097/md.0000000000002974] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The aim of this study was to explore the risk factors associated with longitudinal changes in hemodialysis patients including the correlation between number and distribution of cerebral microbleeds (CMBs). Sixty-one hemodialysis patients were enrolled in this prospective study. Twenty-eight patients had follow-up examinations with a mean interval of 24.79 ± 5.17 months. The number of CMBs was manually counted on susceptibility-weighted imaging. Subjects were divided into 2 groups with and without CMBs. In the CMB group, 8 of 33 patients did not have a mini-mental state examination (MMSE) because of blurred vision. Multiple logistic regression was used to investigate the risk factors for CMBs. Partial correlation was used to explore the correlation between the increased number of CMBs and the change of MMSE scores. CMBs were seen in 33 (54%) hemodialysis patients. Both age and pre/postdialysis systolic blood pressure (SBP) positively correlated with CMBs. Serum iron (SI), and high-density lipoprotein cholesterol (HDL-c) negatively correlated with CMBs (all P < 0.05). Among 25 patients with CMBs and MMSE, 9 patients had scores <27, which was considered as subnormal and most CMBs in these patients were located in the brainstem and basal ganglia. Considering age and follow-up time as the co-confounding factors, the number of new CMBs over the 2 imaging time points negatively correlated with the change of MMSE scores (r = −0.673, P = 0.023). The presence of new CMBs was a risk factor for cognitive dysfunction and the location of CMBs may be correlated with cognitive impairment. Both SI and HDL-c were protective factors for the CMBs. The risk factors for CMBs included age, pre- and postdialysis SBP.
Collapse
|
29
|
Koike K, Fukami K, Kawaguchi A, Shimamatsu K, Yamagishi SI, Okuda S. Regulation of platelet count by erythropoiesis-stimulating agents - iron axis in hemodialysis patients. Int J Nephrol Renovasc Dis 2016; 9:73-80. [PMID: 27099526 PMCID: PMC4822794 DOI: 10.2147/ijnrd.s98196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Higher doses of erythropoiesis-stimulating agents (ESAs) contribute to atherothrombotic cardiovascular disease in hemodialysis (HD) patients. Thrombocytosis is associated with increased mortality in ESA-treated HD patients. We investigated variables affecting platelet count and its variability (platelet count increment [Δplatelet count]) in HD patients. This retrospective longitudinal and observational study of HD outpatients was carried out over 3 years. The outcome was independent determinants of platelet count and Δplatelet count, which were associated with iron indices, ESA dose, and C-reactive protein. In univariate regression analysis, V-shaped relationship was observed between platelet count and transferrin saturation (TSAT), ferritin, serum iron, and hemoglobin (Hb) with the bottom of 0.21, 330 ng/mL, 49 µg/dL, and 10.3 g/dL, respectively. Mixed-effect multivariate regression analysis revealed that TSAT (inversely), Hb ≤10.3 g/dL (inversely), C-reactive protein, and ESA dose were independently associated with platelet count. Δplatelet count was independently and inversely correlated with ΔTSAT and directly correlated with Δferritin. TSAT was independently and inversely associated with ESA dose. ESA dose was directly correlated with iron dose and inversely correlated with TSAT, ferritin ≤330 ng/mL, and Hb ≤10.3 g/dL. ESA dose and TSAT were correlated in determining platelet count and Δplatelet count. Targets of iron indices that reflect iron supply sufficient to avoid platelet count increment and variability may be >21% of TSAT and 300 ng/mL of serum ferritin for appropriate ESA therapy in HD patients.
Collapse
Affiliation(s)
- Kiyomi Koike
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan; The Biostatistics Center, Kurume University, Kurume, Japan
| | - Kei Fukami
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | | | - Kazumasa Shimamatsu
- Shimamatsu Naika Iin (Clinic), Shiseikai Medical Corporation, Chikushino, Japan
| | - Sho-Ichi Yamagishi
- Department of Pathophysiology and Therapeutics of Diabetic Vascular Complications, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Seiya Okuda
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| |
Collapse
|
30
|
Azab SF, Akeel NE, Abdalhady MA, Elhewala AA, Ali ASA, Amin EK, Sarhan DT, Almalky MAA, Elhindawy EM, Salam MMA, Soliman AA, Abdellatif SH, Ismail SM, Elsamad NA, Hashem MIA, Aziz KA, Elazouni OMA, Arafat MS. Serum Hepcidin Levels in Childhood-Onset Ischemic Stroke: A Case-Control Study. Medicine (Baltimore) 2016; 95:e2921. [PMID: 26945394 PMCID: PMC4782878 DOI: 10.1097/md.0000000000002921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Recently, hepcidin, an antimicrobial-like peptide hormone, has evolved as the master regulator of iron homeostasis. Despite the growing evidence of iron imbalance in childhood-onset ischemic stroke, serum hepcidin level in those patients has not yet been researched. In this study, we aimed to estimate serum (hepcidin) level in acute ischemic stroke (AIS) patients and to investigate whether subcutaneous enoxaparin sodium, which is a low-molecular-weight heparin (LMWH) derivative, could modulate serum hepcidin level in those patients. This was a case-control study included 60 (AIS) cases, and 100 healthy children with comparable age and gender as control group. For all subjects' serum hepcidin, interleukin-6 (IL-6), and soluble transferrin receptor [sTfR]) levels were assessed by (enzyme-linked immunosorbent assay [ELISA] method). Iron parameters including (serum iron, ferritin, transferrin, and total iron binding capacity [TIBC]) were also measured. The patients were subdivided according to treatment with an LMWH derivative into 2 groups and serum hepcidin levels were assessed initially and 1 week after stroke onset for all cases. We found that AIS cases had higher serum iron, ferritin, and IL6 levels compared to the control group (all P < 0.01). Serum hepcidin was significantly higher in AIS cases (median, 36[15-73]ng/mL) compared to the control group (median, 24[10-41]ng/mL; P < 0.01). On the 1st day of AIS diagnosis, serum hepcidin levels were similar in both stroke subgroups (P > 0.05). However, on the 7th day of diagnosis serum hepcidin level decreased significantly in AIS cases treated with LMWH (group 1) (median, 36 vs 21 ng/mL; P < 0.01, respectively). Meanwhile, no significant change was observed in serum hepcidin level in AIS cases not treated with LMWH (group 2) (P > 0.05). Serum hepcidin showed significant positive correlations with serum iron, transferrin saturation, ferritin, and IL6 (r = 0.375, P < 0.05; r = 0.453, P < 0.05; r = 0.687, P < 0.01; r = 0.515, P < 0.01; respectively). Our data brought a novel observation of elevated serum hepcidin level in pediatric AIS patients and pointed out that treatment with LMWH could modulate hepcidin level in those patients.
Collapse
Affiliation(s)
- Seham F Azab
- From the Faculty of Medicine, Zagazig University, Al Sharqia Governorate (SFA, NEA, MAA, AAE, ASAA, EKA, DTS, MAAA, EME, MMAS, AAS, SHA, SMI, NAE, MIAH, KAA, OMAE); and Faculty of Medicine, Mansoura University Student hospital, Dakahlia Governorate,Egypt (MSA)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Al Hawsawi ZM, Al-Rehali SA, Mahros AM, Al-Sisi AM, Al-Harbi KD, Yousef AM. High prevalence of iron deficiency anemia in infants attending a well-baby clinic in northwestern Saudi Arabia. Saudi Med J 2015; 36:1067-70. [PMID: 26318463 PMCID: PMC4613630 DOI: 10.15537/smj.2015.9.11844] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 07/08/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the prevalence of iron deficiency anemia (IDA) in infants aged 6-24 months attending the well-baby clinic in primary health care centers (PHCCs). METHODS This cross-sectional epidemiological study was conducted in the Northwestern region of Saudi Arabia from April 2013 to January 2014 in 5 randomly selected PHCCs. The sample size comprised 500 infants, with 100 infants screened from each PHCC. Blood samples were obtained for estimation of hemoglobin and serum ferritin levels. RESULTS Out of 500 infants, 246 (49%) cases had IDA with a mean age of 15.4 ± 6.5 months, with 130 (53%) males, and 116 (47%) females (p=0367). Out of 274 Saudi infants, 126 (51%) cases were diagnosed as IDA. CONCLUSION Iron deficiency anemia is very common in Saudi infants aged 6-24 months. A national program directed for primary prevention and early discovery of IDA in Saudi infants is recommended at PHCCs system. Iron supplementation is to be given at early infancy with universal screening of hemoglobin and ferritin estimation to all infants at 12 months of age.
Collapse
Affiliation(s)
- Zakaria M Al Hawsawi
- Department of Pediatrics, Madinah Maternity & Children's Hospital, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia. E-mail:.
| | | | | | | | | | | |
Collapse
|
32
|
Jimenez K, Khare V, Evstatiev R, Kulnigg-Dabsch S, Jambrich M, Strobl H, Gasche C. Increased expression of HIF2α during iron deficiency-associated megakaryocytic differentiation. J Thromb Haemost 2015; 13:1113-27. [PMID: 25715026 PMCID: PMC4949661 DOI: 10.1111/jth.12884] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 02/12/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Iron deficiency is associated with reactive thrombocytosis; however, the mechanisms driving this phenomenon remain unclear. We previously demonstrated that this occurs alongside enhanced megakaryopoiesis in iron-deficient rats, without alterations in the megakaryopoietic growth factors thrombopoietin, interleukin-6, or interleukin-11. OBJECTIVES The aim of this study was to evaluate megakaryocyte differentiation under iron deficiency in an in vitro model and to investigate potential genes involved in this process. METHODS Human erythroleukemia and megakaryoblastic leukemia cell lines, as well as cord-blood derived hematopoietic stem cells were cultured under iron deficiency. Cell morphology, ploidy, expression of CD41, CD61, and CD42b, and proplatelet formation were assessed in iron-deficient cultures. Polymerase chain reaction arrays were used to identify candidate genes that were verified using real-time polymerase chain reaction. Hypoxia-inducible factor 1, α subunit (HIF2α) protein expression was assessed in bone marrow sections from iron-deficient rats and vascular endothelial growth factor (VEGF)-A in culture supernatants. RESULTS AND CONCLUSIONS Iron deficiency enhanced megakaryoid features in cell lines, increasing ploidy and initiating formation of proplatelet-like structures. In cord blood cell cultures, iron deficiency increased the percentage of cells expressing megakaryopoietic markers and enhanced proplatelet formation. HIF2α and VEGF were identified as potential pathways involved in this process. HIF2α protein expression was increased in megakaryocytes from iron-deficient rats, and VEGF-A concentration was higher in iron-deficient culture supernatants. Addition of VEGF-A to cell cultures increased percentage expression of megakaryocyte CD41. In conclusion, the data demonstrate that iron deficiency augments megakaryocytic differentiation and proplatelet formation and a potential role of HIF2α in megakaryopoiesis.
Collapse
Affiliation(s)
- K Jimenez
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory on Molecular Cancer Chemoprevention, Medical University of Vienna, Vienna, Austria
| | - V Khare
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory on Molecular Cancer Chemoprevention, Medical University of Vienna, Vienna, Austria
| | - R Evstatiev
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - S Kulnigg-Dabsch
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - M Jambrich
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory on Molecular Cancer Chemoprevention, Medical University of Vienna, Vienna, Austria
| | - H Strobl
- Center of Pathophysiology, Infectiology, and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria
- Center of Molecular Medicine, Institute of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - C Gasche
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory on Molecular Cancer Chemoprevention, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
33
|
Lasek-Bal A, Holecki M, Stęposz A, Duława J. The impact of anemia on the course and short-term prognosis in patients with first ever ischemic stroke. Neurol Neurochir Pol 2015; 49:107-12. [PMID: 25890925 DOI: 10.1016/j.pjnns.2015.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/02/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Anemia is the risk factor for cerebrovascular events. The aim of this study was to evaluate the prevalence of anemia among patients with first-ever stroke and its impact on neurological state in the acute phase of the disease and the degree of disability in short-term follow-up. PATIENTS AND METHODS The prospective study included 107 patients aged 72.81 ± 11.12 with the first-ever stroke. Each patient underwent CT of the head and blood tests, including Hb concentration on the first day of hospitalization. We have analyzed the neurological state on the first day of stroke by NIHSS and the functional status on the 14th day after the onset of stroke by mRankin scale in patients with and without anemia. Patients with anemia were additionally divided according to Hb level (less or over 11g/dl). RESULTS Patients with Hb≤ 11g/dl significantly more often achieved a score of 4-5 points on mRankin scale on the 14th day of stroke compared to patients with anemia and Hb>11g/dl. Independent predictors of a worse functional status on the 14th day of stroke in patients with anemia include the neurological state on the 1st day and the hemispheric location of stroke; an independent predictor of death was the neurological state on the 1st day of onset. CONCLUSION Mild anemia did not influence significantly the neurological condition in acute phase of stroke but worsened the functional status in subacute phase of stroke. The neurological state on the first day of stroke and the hemispheric location of cerebral ischemia are independent factors of poor prognosis in patients with anemia in short-term follow-up.
Collapse
Affiliation(s)
- Anetta Lasek-Bal
- Department of Neurology, Medical University of Silesia Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland.
| | - Michał Holecki
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
| | - Arkadiusz Stęposz
- Department of Neurology, Medical University of Silesia Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
| | - Jan Duława
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
| |
Collapse
|
34
|
Shovlin CL. Iron deficiency, ischaemic strokes, and right-to-left shunts: From pulmonary arteriovenous malformations to patent foramen ovale? Intractable Rare Dis Res 2014; 3:60-4. [PMID: 25343129 PMCID: PMC4204536 DOI: 10.5582/irdr.2014.01008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/24/2014] [Indexed: 01/07/2023] Open
Abstract
Has the recent identification of iron deficiency as a risk factor for ischaemic stroke in patients with pulmonary arteriovenous malformations (AVMs) unmasked a new paradigm for stroke/infarct pathogenesis? This commentary reviews evidence that spans associations between iron deficiency and ischaemic strokes, iron deficiency enhancement of platelet aggregation in response to serotonin/5HT, settings in which plasma 5HT is elevated, and clinical trial confirmation that 5HT receptor antagonists prevent ischaemic stroke. The critical leap which directs attention away from atherothrombotic events at the neurovascular wall is that ischaemic strokes due to pulmonary AVMs are attributable to compromised pulmonary capillary bed filtration of venous blood. Right-to-left shunting is continuous through pulmonary AVMs, but also occurs intermittently in approximately 30% of the general population with intracardiac shunts such as patent foramen ovale (PFO). The testable hypothesis presented is that paradoxical embolism of venous platelet-based aggregates may constitute part of the causal chain between iron deficiency and ischaemic stroke, not only in the rare disease state of pulmonary AVMs, but also in major subgroups of the general population.
Collapse
Affiliation(s)
- Claire L. Shovlin
- NHLI Cardiovascular Sciences, Imperial College London, London, UK
- Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
- Address correspondence to: Dr. Claire L. Shovlin, NHLI Cardiovascular Sciences, Imperial Centre for Translational and Experimental Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK. E-mail:
| |
Collapse
|