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Steinman B, Del Rio M, Zolotnitskaya A, Hayde N. A 5-year-old girl with kidney impairment and severe anemia: Answers. Pediatr Nephrol 2023; 38:393-396. [PMID: 35695962 DOI: 10.1007/s00467-022-05608-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Benjamin Steinman
- Division of Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Marcela Del Rio
- Division of Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Anna Zolotnitskaya
- Division of Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Nicole Hayde
- Division of Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, NY, USA.
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Panchal SS, Mishra U, Kothari C, Kothari V, Dalai S, Mecwan M, Chaudhary S, Sharma J, Shah P. Prevalence of anemia in pre-school tribal children with reference to parasitic infections and nutritional impact. J Taibah Univ Med Sci 2022; 17:1087-1093. [PMID: 36212591 PMCID: PMC9519373 DOI: 10.1016/j.jtumed.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/22/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives Anemia is a global health problem and has very high prevalence in developing as well as developed countries, particularly in children and women. The present study evaluates hematological predictors, nutrition deficiency, parasitic infections and their association with the prevalence of anemia. This analysis will help to identify the anemic status of tribal preschool children. Methods This was a cross-sectional study conducted in 300 children (age: 6 months to 5 years) in Santrampur village, Gujarat. Blood was collected and used to determine complete blood count (CBC); we also performed ELISA (enzyme-linked immunoassay) for the estimation of ferritin, transferrin, sTfR (soluble transferrin receptor), vitamin B12 and vitamin B9 (folate). Stool samples were also collected and assessed by ELISA for Entamoeba histolytica, Giardia lamblia and Cryptosporidium parvum. Microscopy was used to screen samples for malaria. Results Of the 300 children analyzed, 87.7% were anemic, 239 children were mildly anemic, 20 were moderately anemic and 4 were severely anemic. Mean Hb level was 9.49 ± 1.47 g/dL; males and females had an Hb level of 9.39 ± 1.59 g/dL and 9.58 ± 1.34 g/dL, respectively. Twenty-six children had sickle cell anemia and five had thalassemia. Over 50% of the children had vitamin B12 and B9 deficiency and 16% had abnormalities in CRP (C-reactive protein) levels. Parasitic infection by C. parvum was positively associated the anemia followed by the prevalence of G. lamblia and E. histolytica. Conclusion An increased awareness of parents in the improvement of sanitary facilities and nutritional counselling with regards to iron-rich food consumption is recommended to if we are to prevent anemia among pre-school children. To reduce parasitic infestation, effective periodic deworming measures are also recommended
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Affiliation(s)
- Shital S. Panchal
- Institute of Pharmacy, Nirma University, Sarkhej-Gandhinagar Highway, Ahmedabad, Gujarat, India
- Corresponding address: Institute of Pharmacy, Nirma University, SG Highway, Ahmedabad, 382 481, Gujarat, India.
| | - Umang Mishra
- Epidemic Branch, Commissionerate of Health, Medical Services and Medical Education (HS), Govt. of Gujarat, Gandhinagar, Gujarat, India
| | - Charmy Kothari
- Institute of Pharmacy, Nirma University, Sarkhej-Gandhinagar Highway, Ahmedabad, Gujarat, India
| | - Vijay Kothari
- Institute of Science, Nirma University, Sarkhej-Gandhinagar Highway, Ahmedabad, Gujarat, India
| | - Sarat Dalai
- Institute of Science, Nirma University, Sarkhej-Gandhinagar Highway, Ahmedabad, Gujarat, India
| | - Marcellin Mecwan
- Institute of Pharmacy, Nirma University, Sarkhej-Gandhinagar Highway, Ahmedabad, Gujarat, India
| | - Shrishma Chaudhary
- Institute of Pharmacy, Nirma University, Sarkhej-Gandhinagar Highway, Ahmedabad, Gujarat, India
| | - Juhi Sharma
- Institute of Pharmacy, Nirma University, Sarkhej-Gandhinagar Highway, Ahmedabad, Gujarat, India
| | - Priyanka Shah
- Institute of Pharmacy, Nirma University, Sarkhej-Gandhinagar Highway, Ahmedabad, Gujarat, India
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Vu C, Bush A, Choi S, Borzage M, Miao X, Nederveen AJ, Coates TD, Wood JC. Reduced global cerebral oxygen metabolic rate in sickle cell disease and chronic anemias. Am J Hematol 2021; 96:901-913. [PMID: 33891719 PMCID: PMC8273150 DOI: 10.1002/ajh.26203] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/18/2022]
Abstract
Anemia is the most common blood disorder in the world. In patients with chronic anemia, such as sickle cell disease or major thalassemia, cerebral blood flow increases to compensate for decreased oxygen content. However, the effects of chronic anemia on oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2 ) are less well understood. In this study, we examined 47 sickle-cell anemia subjects (age 21.7 ± 7.1, female 45%), 27 non-sickle anemic subjects (age 25.0 ± 10.4, female 52%) and 44 healthy controls (age 26.4 ± 10.6, female 71%) using MRI metrics of brain oxygenation and flow. Phase contrast MRI was used to measure resting cerebral blood flow, while T2 -relaxation-under-spin-tagging (TRUST) MRI with disease appropriate calibrations were used to measure OEF and CMRO2 . We observed that patients with sickle cell disease and other chronic anemias have decreased OEF and CMRO2 (respectively 27.4 ± 4.1% and 3.39 ± 0.71 ml O2 /100 g/min in sickle cell disease, 30.8 ± 5.2% and 3.53 ± 0.64 ml O2 /100 g/min in other anemias) compared to controls (36.7 ± 6.0% and 4.00 ± 0.65 ml O2 /100 g/min). Impaired CMRO2 was proportional to the degree of anemia severity. We further demonstrate striking concordance of the present work with pooled historical data from patients having broad etiologies for their anemia. The reduced cerebral oxygen extraction and metabolism are consistent with emerging data demonstrating increased non-nutritive flow, or physiological shunting, in sickle cell disease patients.
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Affiliation(s)
- Chau Vu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
| | - Adam Bush
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
- Department of Radiology, Stanford University, Stanford, CA
| | - Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA
| | - Matthew Borzage
- Division of Neonatology, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Los Angeles, CA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Xin Miao
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
| | - Aart J. Nederveen
- University of Amsterdam, Amsterdam UMC, Radiology and Nuclear Medicine, the Netherlands
| | - Thomas D. Coates
- Division of Hematology-Oncology, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA
- Departments of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - John C. Wood
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
- Division of Cardiology, Departments of Pediatrics and Radiology, Children’s Hospital Los Angeles, Los Angeles, CA
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Coloigner J, Vu C, Borzage M, Bush A, Choi S, Miao X, Chai Y, Galarza C, Lepore N, Tamrazi B, Coates TD, Wood JC. Transient Hypoxia Model Revealed Cerebrovascular Impairment in Anemia Using BOLD MRI and Near-Infrared Spectroscopy. J Magn Reson Imaging 2020; 52:1400-1412. [PMID: 32648323 DOI: 10.1002/jmri.27210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea and nocturnal oxygen desaturations, which are prevalent in sickle cell disease (SCD) and chronic anemia disorders, have been linked to risks of stroke and silent cerebral infarcts (SCI). Cerebrovascular response to intermittent desaturations has not been well studied and may identify patients at greatest risk. PURPOSE To investigate the cerebral dynamic response to induced desaturation in SCD patients with and without SCI, chronic anemia, and healthy subjects. STUDY TYPE Prospective. SUBJECTS Twenty-six SCD patients (age = 21 ± 8.2, female 46.2%), including 15 subjects without SCI and nine subjects with SCI, 15 nonsickle anemic patients (age = 22 ± 5.8, female 66.7%), and 31 controls (age = 28 ± 12.3, female 77.4%). FIELD STRENGTH/SEQUENCE 3T, gradient-echo echo-planar imaging. ASSESSMENT A transient hypoxia challenge of five breaths of 100% nitrogen gas was performed with blood oxygen level-dependent (BOLD) MRI and near-infrared spectroscopy (NIRS) acquisitions. Hypoxia responses were characterized by desaturation depth, time-to-peak, return-to-baseline half-life, and posthypoxia recovery in the BOLD and NIRS time courses. SCI were documented by T2 fluid-attenuation inversion recovery (FLAIR). STATISTICAL TESTS Univariate and multivariate regressions were performed between hypoxic parameters and anemia predictors. Voxelwise two-sample t-statistic maps were used to assess the regional difference in hypoxic responses between anemic and control groups. RESULTS Compared to controls, SCD and chronically anemic patients demonstrated significantly higher desaturation depth (P < 0.01) and shorter return-to-baseline timing response (P < 0.01). Patients having SCI had shorter time-to-peak (P < 0.01), return-to-baseline (P < 0.01), and larger desaturation depth (P < 0.01) in both white matter regions at risk and normal-appearing white matter than patients without infarcts. On multivariate analysis, desaturation depth and timing varied with age, sex, blood flow, white blood cells, and cell-free hemoglobin (r2 = 0.25 for desaturation depth; r2 = 0.18 for time-to-peak; r2 = 0.37 for return-to-baseline). DATA CONCLUSION Transient hypoxia revealed global and regional response differences between anemic and healthy subjects. SCI was associated with extensive heterogeneity of desaturation dynamics, consistent with extensive underlying microvascular remodeling.
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Affiliation(s)
- Julie Coloigner
- CIBORG Laboratory, Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, USA.,Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, Rennes, France
| | - Chau Vu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
| | - Matthew Borzage
- Division of Neonatology, Fetal and Neonatal Institute, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Adam Bush
- Department of Radiology and Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, USA
| | - Xin Miao
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
| | - Yaqiong Chai
- CIBORG Laboratory, Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
| | - Cristina Galarza
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Natasha Lepore
- CIBORG Laboratory, Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Benita Tamrazi
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Thomas D Coates
- Division of Hematology-Oncology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - John C Wood
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA.,Division of Cardiology, Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, California, USA
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Ntenda PAM, Chuang KY, Tiruneh FN, Chuang YC. Multilevel Analysis of the Effects of Individual- and Community-Level Factors on Childhood Anemia, Severe Anemia, and Hemoglobin Concentration in Malawi. J Trop Pediatr 2018; 64:267-278. [PMID: 28977637 DOI: 10.1093/tropej/fmx059] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of this article was to examine individual- and community-level factors associated with childhood anemia, severe anemia, and hemoglobin (Hb) concentration in Malawi. METHODS Using data from the 2010 Malawi demographic and health survey (MDHS), the multilevel regression models were constructed to analyze 2597 children aged 6-59 months living in 849 communities. RESULTS The results showed that both childhood anemia and severe anemia were negatively associated with child's age, no fever in the previous 2 weeks and height-for-age, and positively associated with residing in poor household. Childhood anemia was negatively associated with community female education. Child's age, no fever in the previous 2 weeks and maternal Hb levels were positively associated with child Hb concentration, while residing in poorest households was negatively associated with children's Hb concentration. CONCLUSION Comprehensive public health strategies aimed at reducing childhood anemia need to focus more on the significant characteristics addressed in this study.
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Affiliation(s)
| | - Kun-Yang Chuang
- School of Public Health, Taipei Medical University, No. 250, Wu-Hsing St, Taipei City, Taiwan 110
| | - Fentanesh Nibret Tiruneh
- School of Public Health, Taipei Medical University, No. 250, Wu-Hsing St, Taipei City, Taiwan 110
| | - Ying-Chih Chuang
- School of Public Health, Taipei Medical University, No. 250, Wu-Hsing St, Taipei City, Taiwan 110
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[Aplastic crisis due to parvovirus B19 and Epstein-Barr virus in a patient with hereditary spherocytosis]. An Pediatr (Barc) 2014; 82:e102-7. [PMID: 24629905 DOI: 10.1016/j.anpedi.2013.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 12/20/2013] [Indexed: 11/21/2022] Open
Abstract
Anemic syndrome in childhood requires a diagnosis and urgent treatment guided by systematic protocols that can avoid unnecessary additional testing. The case of a 4 year-old girl with fatigue and intermittent fever of 7 days duration, accompanied by abdominal pain is presented. She had regular general health status, with mucocutaneous jaundice, a grade III/VI/iv murmur, and painful abdomen with hepatosplenomegaly. The blood analysis showed a hypo-regenerative anemia with increased LDH and indirect bilirubin. The Coombs Test was negative, with spherocytes being observed in the peripheral blood smear. The IgM and IgG were positive for parvovirus B19 IgM and Epstein Barr virus, leading to the diagnosis of aplastic crisis in a patient with hereditary spherocytosis. No specific treatment was required. Under the suspicion of anemic syndrome in emergencies, the ABCDE sequence must be followed. Through the history, physical examination and basic laboratory tests, an initial diagnostic approach can be made. Specific etiological tests should be based on this first study.
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Wollmann M, Gerzson BMC, Schwert V, Figuera RW, Ritzel GDO. Reticulocyte maturity indices in iron deficiency anemia. Rev Bras Hematol Hemoter 2014; 36:25-8. [PMID: 24624032 PMCID: PMC3948662 DOI: 10.5581/1516-8484.20140009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 09/10/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to analyze the reticulocyte maturity indices (low, medium, and high fluorescence ratios) in iron deficient 1- to 6-year-old children, and identify the prevalence of iron deficiency anemia in this population. METHODS The present study included 39 subjects, divided into two groups: control subjects (n = 33), and subjects with iron deficiency anemia (n = 6). The results were analyzed by Student's t-test for comparison of means. Differences were considered significant when two-tailed p-value < 0.05. RESULTS Subjects with iron deficiency anemia presented increases in the proportion of mean (10.3 ± 4.7% vs. 6.0 ± 3.4%; p-value = 0.003), and high fluorescence reticulocytes (2.3 ± 0.87% vs. 0.9 ± 0.9%; p-value = 0.03) compared to the control group. The prevalence of anemia in this population was 15% (n = 6). CONCLUSION The indices related to immaturity of reticulocytes are higher in the presence of iron deficiency, thus demonstrating a deficiency in the raw material to form hemoglobin and are, therefore, possible early markers of iron deficiency and anemia. We emphasize the need to standardize these indices for use in clinical practice and lab test results.
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Affiliation(s)
- Muriel Wollmann
- Laboratório de Análises Clínicas J&R, Candelária, RS, Brazil
| | | | - Vanessa Schwert
- Universidade de Santa Cruz do Sul (UNISC), Santa Cruz, RS, Brazil
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Ghorashi Z, Nezami N, Ghalehgolab Behbahan A, Ghorashi S. Supplemental food may not prevent iron-deficiency anemia in infants. Indian J Pediatr 2008; 75:1121-4. [PMID: 18810337 DOI: 10.1007/s12098-008-0191-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 04/04/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The present study evaluates the role of supplementary food and medicinal iron intake in preventing iron deficiency anemia in children aged between 4 to 6 months. METHODS During a case-control study in "Tabriz Children Hospital", nutritional and medicinal-iron intake of 60 consecutively selected patients with iron-deficiency anemia were compared with 60 non-anemic children of similar age and sex distributions. RESULTS The mean hemoglobin concentration, corpuscular volume and serum iron were 9.11 g/dl, 65.41 fL and 19.33 microg/dl, in case group; and 12.6 g/dl, 75.18 fL and 78.28 microg/dl, in control group, respectively. There was no statistically significant difference between age of case and control groups when complementary-semisolid foods were started (P=0.058), but the mean of received medicinal iron in case group was significantly lower than control group (P<0.001). CONCLUSION Supplementary food intake alone is not efficient to prevent iron deficiency anemia since the age of 4-6 months. So, regular administration of medicinal iron is crucial to prevent iron-deficiency anemia in children aged 4-6 months.
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Affiliation(s)
- Ziaaedin Ghorashi
- Department of Pediatrics, Tabriz Children Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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