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El Adioui G, Imrani K, Ettouhami B, Moatassim Billah N, Nassar I. [Jejuno-ileal fold pattern reversal]. Rev Med Interne 2024; 45:48-49. [PMID: 37891045 DOI: 10.1016/j.revmed.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/24/2023] [Indexed: 10/29/2023]
Affiliation(s)
- G El Adioui
- Service de radiologie centrale, CHU Ibn Sina, Rabat, Maroc.
| | - K Imrani
- Service de radiologie centrale, CHU Ibn Sina, Rabat, Maroc
| | - B Ettouhami
- Service de réanimation centrale, CHU Ibn Sina, Rabat, Maroc
| | | | - I Nassar
- Service de radiologie centrale, CHU Ibn Sina, Rabat, Maroc
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Bigot W, Forzy L, Nassarmadji K, Champion K, Asesio N, Mouly S, Sène D, Comarmond C, Brenac G, Chaudot F, Gasparini S, Leghima L. Une anémie dans les chaussettes mon cher Michel. Rev Med Interne 2023; 44:676-678. [PMID: 37419730 DOI: 10.1016/j.revmed.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Affiliation(s)
- W Bigot
- Département de médecine interne et immunologie clinique, hôpital Lariboisière, AP-HP, université Paris Citém, Paris, France.
| | - L Forzy
- Département de médecine interne et immunologie clinique, hôpital Lariboisière, AP-HP, université Paris Citém, Paris, France
| | - K Nassarmadji
- Département de médecine interne et immunologie clinique, hôpital Lariboisière, AP-HP, université Paris Citém, Paris, France
| | - K Champion
- Département de médecine interne et immunologie clinique, hôpital Lariboisière, AP-HP, université Paris Citém, Paris, France
| | - N Asesio
- Service de gastro-entérologie, GH Lariboisière - St Louis, AP-HP, université Paris Cité, Paris, France
| | - S Mouly
- Département de médecine interne et immunologie clinique, hôpital Lariboisière, AP-HP, université Paris Citém, Paris, France
| | - D Sène
- Département de médecine interne et immunologie clinique, hôpital Lariboisière, AP-HP, université Paris Citém, Paris, France
| | - C Comarmond
- Département de médecine interne et immunologie clinique, hôpital Lariboisière, AP-HP, université Paris Citém, Paris, France
| | - G Brenac
- Service de médecine interne, CHU de Dijon, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon Cedex, France
| | - F Chaudot
- Service de médecine interne, Hospices Civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - S Gasparini
- Service de médecine interne, CHU de Poitiers, CHU de Poitiers, 2 rue de la Milétrie, CS 90577, 86000 Poitiers, France
| | - L Leghima
- Service de médecine interne, CHU d'Amiens-Picardie, Site Sud, 1, rond-point du Professeur Christian Cabrol, 80054 Amiens Cedex 1, France
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Galactéros F. Le globule rouge drépanocytaire. Données génétiques et structurelles. Rev Med Interne 2023; 44:4S2-4S6. [PMID: 38049243 DOI: 10.1016/s0248-8663(23)01302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Sickle cell disease is syndromic, associating a hemolytic anemia, a vaso-obstructive vascular disease, and an infectious risk linked to the precocity of the splenic function loss. The willingly hyperacute and potentially fatal character of the two last elements of the pathophysiologic syndrome, has, quite rightly, focused the therapeutic researches on them. Great success in those two domains have allowed a very important gain in life expectancy. However, chronic progressive organ dysfunction began to appear in older than 25 years-old patients. It concerns mainly renal, hepatic, cardiac functions and pulmonary arterial pressure and may lead to organ failure and premature death. Since some 25 years, the clinical research demonstrated an association between such complications and intravascular hemolytic rate, and it turned to a causative relationship. This present paper try to summarize the actual knowledge on the structural and genetic aspects of sickle cell anemia hemolysis. © 2023 Société nationale française de médecine interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- F Galactéros
- Unité des maladies génétiques du globule rouge (UMGGR), médecine interne, GHU Henri-Mondor AP-HP et U-PEC, France.
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Habibi A, Pirenne F. Les anémies aiguës et la stratégie transfusionnelle chez les drépanocytaires adultes. Rev Med Interne 2023; 44:4S12-4S17. [PMID: 38049241 DOI: 10.1016/s0248-8663(23)01304-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Worsening of anemia is very common in sickle cell disease. It is important to investigate specific complications related to sickle cell disease but also other causes of anemia in general. Transfusions or exchange transfusions are major therapeutic options and are frequently used for acute complications of sickle cell disease but also for primary and secondary prevention of some of the chronic complications. The transfusion strategy has been modified since the awareness of post-transfusion hemolysis by taking into account the transfusion risk score. A strong collaboration between the patient's expert center, the Blood center and the patient's hospitalization unit is required to make decisions. © 2023 Société nationale française de médecine interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- A Habibi
- Centre de référence des syndromes drépanocytaires majeurs, unité des maladies génétiques du globule rouge, CHU Henri-Mondor, AP-HP, Créteil, France; INSERM-U955, institut Mondor, université Paris-Est Créteil, team 2 Transfusion et maladies du globule rouge, laboratoire d´excellence GR-Ex, Créteil, France.
| | - F Pirenne
- INSERM-U955, institut Mondor, université Paris-Est Créteil, team 2 Transfusion et maladies du globule rouge, laboratoire d´excellence GR-Ex, Créteil, France; Établissement français du sang Île-de-France, Paris, France
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Lesesve JF, Perrin J. Binge drinking alongside alcoholic chronic abuse. Morphologie 2023; 107:154-155. [PMID: 35606281 DOI: 10.1016/j.morpho.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/15/2022] [Accepted: 04/24/2022] [Indexed: 11/15/2022]
Abstract
Here is reported the case of an adult patient with ethylic cirrhosis associated with spur cell anemia. Moreover, acute vacuolation of leukocytes was observed in relationship with recent binge drinking.
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Affiliation(s)
| | - Julien Perrin
- Service d'hématologie biologique, centre hospitalier universitaire, Nancy, France
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Lobbes H. [Pure red cell aplasia: Diagnosis, classification and treatment]. Rev Med Interne 2023; 44:19-26. [PMID: 36336519 DOI: 10.1016/j.revmed.2022.10.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
Pure red cell aplasia (PRCA) is a rare anemia characterised by profound reticulocytopenia caused by a marked reduction in bone marrow erythroblasts, without abnormalities in other blood lineages. Blackfan-Diamond anemia is an inherited ribosomopathy responsible for a hereditary form of PRCA. Acquired PRCA are separated in primary and secondary forms, including Parvovirus B19 infection, thymoma, lymphoproliferative disorders, autoimmune diseases (lupus) and drug-induced PRCA. The pathophysiology of PRCA is not fully understood and involves both humoral and T lymphocyte autoreactive cells. In Parvovirus B19-related PRCA, treatment is based on polyvalent immunoglobulins. Thymectomy for thymoma is mandatory but results in prolonged remission in a limited number of cases. The therapeutic strategy is based on expert opinion: corticosteroids in monotherapy provide few sustained responses. The choice of an additional immunosuppressant drug is guided by the presence of an underlying disease. In most cases, cyclosporine A is the first choice providing the best response rate but requires a concentration monitoring (150 to 250 ng/mL). The second choice is cyclophosphamide in large granular lymphocyte leukaemia. Sirolimus (mTOR inhibitor) seems to be a promising option especially in refractory cases. Transfusion independence is the main objective. If the patient receives numerous red blood cell transfusions (> 20 packs), iron overload assessment is crucial to initiate an iron chelation. A retrospective and prospective national cohort (EPIC-F) has been set up and is now available to include each case of PRCA to improve the knowledge of this disease and to optimize the therapeutic strategy.
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Affiliation(s)
- Hervé Lobbes
- Service de médecine interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000 Clermont-Ferrand, France.
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Aniort J, Greze C, Kosmadakis G. Innovations thérapeutiques dans la prise en charge de l’ anémie de la maladie rénale chronique Therapeutic innovations in the management of chronic kidney disease-associated anemia. Nephrol Ther 2022; 18:6S25-6S32. [PMID: 36585122 DOI: 10.1016/s1769-7255(22)00650-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Anemia is a common complication of chronic kidney disease (CKD). The insufficient erythropoietin (EPO) production by the kidneys and iron deficiency are the main causes. Iron supplementation and the administration of recombinant EPO are the main treatment modalities. New iron formulations that can be administered orally, intravenously or directly via the dialysate have recently been developed to improve efficacy and tolerance. Ferric citrate administered orally can effectively corrects anemia in case of iron deficiency and in addition chelate phosphate in the gut lumen. Ferric carboxymaltose allows intravenous administration of larger doses given less frequently. Ferric pyrophosphate citrate administered directly via the dialysate allows the compensation of iron losses during the hemodialysis session. HIF-prolyl-hydroxylase inhibitors are a new therapeutic class of erythropoiesis-stimulating agents. Orally administered, they act by stabilizing the HIF transcription factor involved in the initiation of erythropoietin production by hypoxia. Several clinical studies have recently evaluated these new molecules in comparison with recombinant EPO. In CKD patients not yet on dialysis or undergoing dialysis therapy non-inferiority in correcting anemia has been demonstrated compared with recombinant EPO. The decrease in circulating hepcidin they induce appears greater than that induced by injectable recombinant EPO. Presently available reports on the safety of HIF-prolyl-hydroxylase inhibitors are reassuring but need to be confirmed in longer-term studies of larger size. © 2022 Published by Elsevier Masson SAS on behalf of Société francophone de néphrologie, dialyse et transplantation.
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Affiliation(s)
- Julien Aniort
- Service de néphrologie, dialyse et transplantation rénale, CHU de Clermont-Ferrand, France; Unité de nutrition humaine, UMR, université Clermont-Auvergne, UMR 1019 INRA, France.
| | - Clarisse Greze
- Service de néphrologie, dialyse et transplantation rénale, CHU de Clermont-Ferrand, France
| | - George Kosmadakis
- AURA santé, rue Marie-Marvingt, ZAC Les Montels III, 63118 Cébazat, France
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Choukroun G, Kazes I, Dantal J, Vabret E, Couzi L, Le Meur Y, Trochu JN, Cacoub P; investigateurs de l’étude CARENFER IRC. [Prevalence of iron deficiency in patients with non-dialysis chronic kidney disease: The CARENFER national, multicentre, observational study]. Nephrol Ther 2022; 18:195-201. [PMID: 35241379 DOI: 10.1016/j.nephro.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/08/2021] [Accepted: 12/19/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Iron deficiency is common and associated with worse outcomes in patients with non-dialysis chronic kidney disease. We performed a national, multicentre, observational and transversal study to assess the prevalence of iron deficiency as well as current iron deficiency screening practices in this population. PATIENTS AND METHODS A total of 25 nephrology centres in France participated in the study. All adult non-dialysis chronic kidney disease patients who met the inclusion (GFR>15mL/min/1.73m2) and exclusion criteria and provided consent were systematically recruited over a 4-week inclusion period. Investigators were asked to perform a blood test (hemoglobin concentration, serum iron, serum ferritin and transferrin saturation) and to complete a questionnaire about their iron status monitoring practices. The primary objective was to assess the prevalence of iron deficiency (serum ferritin<100μg/L and/or transferrin saturation<20%). Secondary objectives were to evaluate the prevalence of absolute iron deficiency (serum ferritin<100μg/L and transferrin saturation<20%) and functional iron deficiency (serum ferritin≥100μg/L and transferrin saturation<20%), the prevalence of iron deficiency according to haemoglobin concentration and chronic kidney disease stage, the proportion of centres that perform routine evaluation of iron status and the number of patients receiving iron supplementation. RESULTS A total of 1211 patients with non-dialysis chronic kidney disease were included in the analysis. The overall prevalence of iron deficiency was 47.1%. The rates of absolute iron deficiency and functional iron deficiency and anaemia were 13.4% and 17.1%, respectively. Among the 25 participating centres, 12 reported routine assessment of iron status in non-dialysis chronic kidney disease patients. CONCLUSION In this observational study, a high prevalence of iron deficiency was observed among non-dialysis chronic kidney disease patients. Less than half of participating centres reported routine assessment of iron status.
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Laras H, Haddoum F, Baghdali FY, Gagi N, Koceir EHA, Bitam A. [Prevalence of malnutrition and absolute and functional iron deficiency anemia in nondialysis-dependent chronic kidney disease and hemodialysis Algerian patients]. Nephrol Ther 2022; 18:237-246. [PMID: 35644772 DOI: 10.1016/j.nephro.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/23/2022] [Accepted: 03/10/2022] [Indexed: 11/18/2022]
Abstract
In chronic kidney disease, anemia and malnutrition coupled with inflammation as malnutrition-inflammation complex syndrom are common and considered as morbidity-mortality factors. The link between these two factors has been described at length in the literature highlighting an association of malnutrition with iron deficiency considered itself as one of the causes of anemia in chronic kidney disease (non-dialysis and hemodialysis). Our study aims to know the prevalence of these two factors in a population of chronic kidney disease (non-dialysis and hemodialysis) of Algiers and to highlight the possible associations between them. PATIENTS AND METHODS This is a multicentre, cross-sectional and descriptive study carried out over a period of 6months (August 2018 to January 2019). Anemia and malnutrition were assessed by various biological and clinical tools such as the malnutrition inflammation score and the International Society of Renal Nutrition and Metabolism criteria. Statistical tests were performed on the R studio software, considering P<0.05 as a statistically significant value. RESULTS Two hundred and nine patients on chronic kidney disease were included (90 non dialysis and 119 hemodialysis). The median age was 70 (IQR=16) for non dialysis and 56 (IQR=16.5) for hemodialysis. The prevalence of anemia was 66.66% (n=60) in non dialysis and 70.58% (n=84) in hemodialysis. Absolute iron deficiency anemia was higher in non dialysis (48.33%; n=29) while functional iron deficiency anemia was higher in hemodialysis (34.52%; n=29). The prevalence of malnutrition by malnutrition inflammation score was relatively low. Only functional iron deficiency anemia was associated with malnutrition. CONCLUSION The prevalence of anemia was higher in Algerian chronic kidney disease (non-dialysis and hemodialysis) unlike malnutrition which remains associated with functional iron deficiency anemia.
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Affiliation(s)
- Hayat Laras
- Département de biologie et physiologie des organismes (BPO), laboratoire de bioénergétique et métabolisme intermédiaire, Faculté des Sciences Biologiques, université des sciences et de la technologie Houari Boumediene (USTHB), Alger, Algérie; Département de médecine, faculté des sciences de la santé, laboratoire risque cardiovasculaire en néphrologie et transplantation, université d'Alger 1, Alger, Algérie.
| | - Farid Haddoum
- Département de médecine, faculté des sciences de la santé, laboratoire risque cardiovasculaire en néphrologie et transplantation, université d'Alger 1, Alger, Algérie; Service de néphrologie, hémodialyse et transplantation, Centre Hospitalier Universitaire Mustapha Pacha, Alger, Algérie
| | - Feriel-Yasmine Baghdali
- Département de médecine, faculté des sciences de la santé, laboratoire risque cardiovasculaire en néphrologie et transplantation, université d'Alger 1, Alger, Algérie; Service de néphrologie, hémodialyse et transplantation, Centre Hospitalier Universitaire Mustapha Pacha, Alger, Algérie
| | - Nadia Gagi
- Département de médecine, faculté des sciences de la santé, université d'Alger 1 et laboratoire central de biochimie, Centre Hospitalier Universitaire Mustapha Pacha, Alger, Algérie
| | - El Hadj Ahmed Koceir
- Département de biologie et physiologie des organismes (BPO), laboratoire de bioénergétique et métabolisme intermédiaire, Faculté des Sciences Biologiques, université des sciences et de la technologie Houari Boumediene (USTHB), Alger, Algérie
| | - Arezki Bitam
- Département de biologie et physiologie des organismes (BPO), laboratoire de bioénergétique et métabolisme intermédiaire, Faculté des Sciences Biologiques, université des sciences et de la technologie Houari Boumediene (USTHB), Alger, Algérie; Département de technologie alimentaire, École nationale supérieure agronomique (ENSA), Laboratoire de recherche en technologie alimentaire et nutrition humaine, El-Harrach, Alger, Algérie
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Aggarwal P, Sinha SK, Khanra D, Razi M, Nath RK, Shrivastava A. Hematinic deficiency in patients with heart failure with reduced ejection fraction (HFrEF). Ann Cardiol Angeiol (Paris) 2021; 71:153-159. [PMID: 34615606 DOI: 10.1016/j.ancard.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Hematinic deficiency irrespective of anemia is not uncommon in patients with heart failure. We studied the prevalence, distribution, and etiology of anemia in patients with heart failure with reduced ejection fraction (HFrEF) and compared it with non-anemic patients. METHODS Congestive heart failure (CHF) was diagnosed by modified Framingham criteria and ejection fraction (EF) <40%. Iron deficiency (ID) anemia was defined as serum ferritin level <100 ng/ml (absolute) or 100-300 ng/ml with transferrin saturation <20% (functional). Vitamin B12 and folate deficiency were defined as <200pg/ml and <4ng/ml respectively. RESULT 688 patients with HFrEF were studied with an overall mean age of 57.2±13.8 years, and males outnumbering females (62.3% vs. 37.7%). Coronary artery disease (44.2%), dilated cardiomyopathy (46.8%), and valvular heart disease (6.7%) were major causes of CHF.Anemia was found in 63.9% of patients. Vit B12 deficiency, and folate deficiency were found in 107 (15.55%), and 54 (7.85%) subjects, respectively. Absolute ID was detected in 186 (42.27%) patients with anemia and 84 (33.87%) patients without anemia, while functional ID was present in 80 (18.18%) patients with anemia and 29 (11.69%) patients without anemia. Vitamin B12 deficiency was noted in 70 (15.9%) patients with anemia and 37 (14.9%) patients without anemia, while folate deficiency was noted in 31 (7.04%) patients with anemia and 23 (9.2%) patients without anemia. Hematinic deficiency among the study population was distributed equally among patients irrespective of EF, NYHA class, socioeconomic class diet pattern. CONCLUSION The study shows that hematinic deficiency was seen even in non-anemic patients irrespective of diet pattern. Supplementation could be a strong strategy to improve outcomes in these patients of heart failure irrespective of anemia and should be evaluated in prospective studies.
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Affiliation(s)
| | | | - Dibbendhu Khanra
- Fellow, Department of Cardiology, New Cross Hospital, Royal Wolverhampton NHS Trust
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Razafitahinjanahary CL, Rasolofonarivo RH, Rakototiana AF, Rantomalala HYH. [A case of voluminous benign hypertrophy of the prostate complicated by rectal perforation]. Prog Urol 2021; 31:446-447. [PMID: 33612445 DOI: 10.1016/j.purol.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 11/27/2022]
Affiliation(s)
- C L Razafitahinjanahary
- Service d'urologie du centre hospitalier universitaire Joseph Ravoangy Andrianavalona, Antananarivo, Madagascar; Faculté de médecine de l'Université d'Antananarivo, Antananarivo, Madagascar.
| | - R H Rasolofonarivo
- Service d'urologie du centre hospitalier universitaire Joseph Ravoangy Andrianavalona, Antananarivo, Madagascar; Faculté de médecine de l'Université d'Antananarivo, Antananarivo, Madagascar.
| | - A F Rakototiana
- Service d'urologie du centre hospitalier universitaire Joseph Ravoangy Andrianavalona, Antananarivo, Madagascar; Faculté de médecine de l'Université d'Antananarivo, Antananarivo, Madagascar.
| | - H Y H Rantomalala
- Service d'urologie du centre hospitalier universitaire Joseph Ravoangy Andrianavalona, Antananarivo, Madagascar; Faculté de médecine de l'Université d'Antananarivo, Antananarivo, Madagascar.
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Brunet P, Choukroun G, Moulin B, Zaoui P, Thervet É, Frimat L, Chazot C. [Use of iron in nephrology: Results of a French practical survey]. Nephrol Ther 2020; 16:153-7. [PMID: 32409289 DOI: 10.1016/j.nephro.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/20/2019] [Indexed: 11/23/2022]
Abstract
The French-speaking Society of Nephrology, Dialysis and Transplantation conducted, in 2018, a survey among French nephrologists into their iron prescribing habits for patients with chronic kidney disease stages 3 to 5 before dialysis. The results show that 73% of nephrologists use intravenous iron before dialysis stage. When a patient has gastrointestinal symptoms under oral iron therapy, only 48% of nephrologists use intravenous route. The starting thresholds for iron are for 78% of nephrologists a transferrin saturation <20% and for 80% a serum ferritin <100 μg/L. Only 14% start iron when a transferrin saturation <25% or higher and 29% start iron when serum ferritin <200 μg/L or higher. High dosages of iron (500 and 1000 mg) are used by 58% of nephrologists. Finally, about 30% of nephrologists refer to various barriers to intravenous iron prescription, such as cost, unavailability of intravenous iron in their facility or lack of day hospital unit. The correction of iron deficiency without anemia remains controversial. It is performed by only 43% of nephrologists. These results show an improvement of the practices compared to a 2006 survey. However, they indicate a sub-prescription of iron compared to the European recommendations which recommend a starting threshold of iron of transferrin saturation <25% and ferritinemia <200 μg/L in anemic patients not treated with erythropoietin-stimulating agents.
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Sylla C, Dao SZ, Dembele S, Sylla M, Traoré BA, Coulibaly A, Kanté I, Traoré MS, Sima M, Sidibé K, Traoré SO, Guindo S, Diarra I, Bocoum A, Traoré Y, Mounkoro N. [Materno-Fetal Prognosis Of Anemia In Bougouni]. Mali Med 2020; 35:39-41. [PMID: 37978745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
GOAL The goal was to assess the maternal-fetal prognosis of anemia in pregnant women in the Bougouni reference health center. METHODS We carried out a prospective descriptive and analytical cross-sectional study from January 1 to December 31, 2013 at the Bougouni reference health center. It covered all pregnant women with a hemoglobin level below 11g/dl regardless of the outcome of the pregnancy. RESULTS The prevalence of anemia in pregnant women was 33.2%. They were women married to peasants in 88.6% of cases, unschooled in 93.2% of cases, having not done antenal care in 56.8% of cases. Malaria was the most common etiology in 75% of cases. Anemia was severe in 61.4% of cases. The maternal-fetal prognosis was dominated by 3.3% of maternal death, 12.5% of abortion, 7.6% of prematurity and 6.8% of fetal death in utero. CONCLUSION Anemia in pregnant women is the source of many maternal-fetal complications.
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Affiliation(s)
- C Sylla
- Centre de santé de référence de Bougouni
| | - S Z Dao
- Centre de santé de référence de la commune II
| | | | - M Sylla
- Centre de santé de référence de Bougouni
| | - B A Traoré
- Centre de santé de référence de la commune II
| | | | - I Kanté
- Centre hospitalo-universitaire du Point G
| | - M S Traoré
- Centre hospitalo-universitaire du Point G
| | - M Sima
- Centre hospitalo-universitaire du Point G
| | - K Sidibé
- Hôpital Nianankoro Fomba de Ségou
| | - S O Traoré
- Centre de santé de référence de la commune V
| | - S Guindo
- Centre de santé de référence de Bougouni
| | - I Diarra
- Centre hospitalo-universitaire le Luxemburg
| | - A Bocoum
- Centre hospitalo-universitaire Gabriel Touré
| | - Y Traoré
- Centre hospitalo-universitaire Gabriel Touré
| | - N Mounkoro
- Centre hospitalo-universitaire Gabriel Touré
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Rissatto-Lago MR, Fernandes LDC, Alves AAG, de Oliveira ACG, de Andrade CLO, Salles C, Ladeia AMT. Dysfunction of the auditory system in sickle cell anaemia: a systematic review with meta-analysis. Trop Med Int Health 2019; 24:1264-1276. [PMID: 31495037 DOI: 10.1111/tmi.13307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe the occurrence of both peripheral and central auditory system dysfunction in sickle cell anaemia (SCA) patients and discuss the different mechanisms hypothesised to be responsible for these alterations. METHODS An electronic search was conducted using PubMed Central® (MEDLINE), LILACS® and Scopus® databases. This systematic review was performed in accordance with the PRISMA statement. Original observational studies that utilised audiological tests for auditory system evaluations in SCA were included. RESULTS A total of 183 records were found in the databases searched. Twenty-one of these studies met the inclusion criteria. Pooled prevalence of sensorineural hearing loss (SNHL) was 20.5% (CI: 10.3-33%). Retrocochlear involvement was detected with the auditory brainstem response, which assesses integrity of the cochlea, 8th cranial nerve and brainstem structures. In addition, the increase in otoacoustic emission amplitudes in SCA patients indicates changes in cochlear micromechanics and precedes the expression of a detectable cochlear pathology. CONCLUSION The prevalence of the SNHL is higher than in the general population. Dysfunction of the auditory system may be present in SCA patients, with the most probable mechanism being the presence of circulatory disturbances resulting from the chronic inflammatory state of the disease.
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Affiliation(s)
- Mara Renata Rissatto-Lago
- Postgraduate Course in Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, Brazil.,College of Speech Therapy, State University of Bahia, Cabula, Brazil
| | | | | | | | | | - Cristina Salles
- Postgraduate Course in Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, Brazil.,Department of Otolaryngology, University Hospital Professor Edgar Santos, Salvador, Brazil
| | - Ana Marice Teixeira Ladeia
- Postgraduate Course in Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, Brazil
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15
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Romanet T, Bedouch P, Zaoui P. [Assessment of iron deficiency anemia management in the general hospital of Grenoble: A 12-month follow-up of an intravenous ferric carboxymaltose treatment program in a cohort of patients with non-dialysis-dependent chronic kidney disease]. Nephrol Ther 2019; 15:104-109. [PMID: 30803900 DOI: 10.1016/j.nephro.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/19/2018] [Accepted: 10/25/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The FIND-CKD study has validated the use of ferric carboxymaltose (FCM) injection with a target of ferritin level between 400 and 600ng/mL to treat iron deficiency anemia in non-dialysis-dependent chronic kidney disease (ND-CKD) patients. In order to assess this strategy in clinical practice, we constituted a cohort of patients within our nephrology department. PATIENTS AND METHODS Patients had CKD stages 3 to 5, hemoglobin level (Hb)<13g/dL (men) or<12g/dL (women), and ferritin level (F)<100ng/mL or transferrin saturation (TSAT)<20%. They were not treated by erythropoiesis-stimulating agent (ESA) for at least one month, and oral iron had been poorly tolerated or ineffective. FCM first dose was adjusted according to patient weight. A new infusion was possible, at least one month after the first, with a half-dose if TSAT<20% but F≥200ng/mL; no perfusion was performed if F≥400ng/mL. RESULTS In all, 53 patients were included with a mean Hb of 11.4g/dL and a mean TSAT of 16%. Over one year of follow-up, only 12 patients (22.6%) needed another treatment for anemia (blood transfusion or ESA). No patient showed a significant decrease in Hb. In all, 62% of patients received only one infusion of FCM. CONCLUSION The administration of FCM IV with ferritin levels in the recommended target has proven effective in correcting anemia of ND-CKD patients while limiting the use of another therapeutic strategy.
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Affiliation(s)
- Thierry Romanet
- Service de néphrologie, dialyses, aphérèses, transplantation rénale, CHU Grenoble-Alpes, CS 10 217, 38043 Grenoble cedex 9, France; Pôle pharmacie, pharmacie clinique, secteur soins pharmaceutiques, CHU Grenoble-Alpes, CS 10 217, 38043 Grenoble cedex 9, France
| | - Pierrick Bedouch
- Pôle pharmacie, pharmacie clinique, secteur soins pharmaceutiques, CHU Grenoble-Alpes, CS 10 217, 38043 Grenoble cedex 9, France
| | - Philippe Zaoui
- Service de néphrologie, dialyses, aphérèses, transplantation rénale, CHU Grenoble-Alpes, CS 10 217, 38043 Grenoble cedex 9, France.
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16
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Ntima G, Bepouka B, Tixier V, Ferrier N, Marcaggi X. [Anemia in patients with acute coronary syndrome in the Vichy Hospital center]. Ann Cardiol Angeiol (Paris) 2018; 67:321-6. [PMID: 30266204 DOI: 10.1016/j.ancard.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Objectives were to determine the clinical, epidemiological and biological profile of the patients suffering from acute coronary syndrome and presenting the anaemia, the determinants of variation of the haemoglobin rate, and to estimate the impact of the anaemia on the prognosis of these patients. PATIENTS AND METHODS Retrospective and observational study conducted in the cardiology department of Vichy Hospital in France. All patients with acute coronary syndrome admitted from 31 of October 2015 to 30 of April 2016 were selected. The patients were followed for 1 month. The anaemia was defined by: less than 13g/dL in man and less than 12g/L in woman (WHO definition). Biological markers were taken at the admission. Factors associated to the haemoglobin rate were analysed by multivariate linear regression and those associated to the mortality within 30 days were analysed by logistic regression. RESULTS Among 251 included patients, there were 180 males and 71 females with the average age of 67 years. 94 patients had ST elevation myocardial infarction (STEMI), 116 had Non ST myocardial infarction (NSTEMI) and 41 had unstable angina. Haemoglobin value was known in 238 patient's, among whom 44.1% were anaemic (105/238). The anaemia was more frequent in women. The tobacco was less frequent; High blood pressure, renal failure, malnutrition, subclinical atherosclerosis, lower limb arteritis and the inflammatory syndrome were more frequent in patients with anaemia. They presented more complications. The age (P=0,003), the pulsed pressure (P=0,007), LVEF (P=0,005), the albumin (P=0,010), Creatine kinase (CK) level (P=0,048) and of CRP (P=0,011), were linear factors of variations of the haemoglobin rate (R2=0,955). Ten patients died during the follow-up. The multivariate analysis revealed the anaemia as independently associated with the mortality in 30 days (Odds Ratio 3,69; P=0,02). CONCLUSION Anaemia is frequent in patients with an ACS, and it is associated with a particular clinical and biological profile. The patients with anaemia have a mortality rate in 30 days higher than the patients without anaemia.
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Brissot P, Troadec MB, Loréal O, Brissot E. Pathophysiology and classification of iron overload diseases; update 2018. Transfus Clin Biol 2019; 26:80-8. [PMID: 30173950 DOI: 10.1016/j.tracli.2018.08.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/19/2022]
Abstract
Iron overload pathophysiology has benefited from significant advances in the knowledge of iron metabolism and in molecular genetics. As a consequence, iron overload nosology has been revisited. The hematologist may be confronted to a number of iron overload syndromes, from genetic or acquired origin. Hemochromatoses, mostly but not exclusively related to the HFE gene, correspond to systemic iron overload of genetic origin in which iron excess is the consequence of hepcidin deficiency, hepcidin being the hormone regulating negatively plasma iron. Iron excess develops following hypersideremia and the formation of non-transferrin-bound iron, which targets preferentially parenchymal cells (hepatocytes). The ferroportin disease has a totally different iron overload mechanism consisting of defective egress of cellular iron into the plasma, iron deposition taking place mostly within the macrophages (spleen). Hereditary aceruloplasminemia is peculiar since systemic iron overload involves the brain. Two main types of acquired iron overload can be seen by the hematologist, one related to dyserythropoiesis (involving hypohepcidinemia ), the other related to multiple transfusions (thalassemias, myelodysplasia, hematopoietic stem cell transplantation). Congenital sideroblastic anemias, either monosyndromic (anemia) or polysyndromic (anemia plus extra-hematological syndromes), develop both compartimental iron excess within the erythroblast mitochondria, and systemic iron overload (through dyserythropoiesis and/or transfusions).
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Langlais ML, Dargère M, Le Niger C, Goetghebeur D. [Appropriate use of red blood cell transfusion in the emergency department before and after a specific protocol]. Transfus Clin Biol 2018; 26:38-47. [PMID: 29673931 DOI: 10.1016/j.tracli.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/16/2018] [Indexed: 01/14/2023]
Abstract
The purpose of this study was to assess appropriateness of red blood cell (RBC) transfusion in the emergency department before and after a specific protocol. METHODS A retrospective monocenter study was realized during two six-month periods at the emergency unit. A protocol based on the French national guidelines (HAS) in 2014 was set up between the two periods. All the adult patients, except in a context of massive transfusion, were included in the study. The principal criteria analysed was the rate of appropriate transfusion. RESULTS Ninety-five patients were included during the first period (group 1) and 98 during the second one (group 2). The rate of appropriateness was the same in the two groups (81% for the group 1 and 81.6% for the group 2). The inappropriate indications were more frequent with older patients (74.6 ± 15.2 years in the group 1 and 79.5 ± 8.5 in the group 2, P=0.01) and patients suffering from a stable coronary artery disease (18.5% in the group 1 and 38.9% in the group 2, P=0.008). CONCLUSION The rate of appropriate red blood cells transfusion, already high at the beginning of the study, could not be significantly improved with the institution of a specific protocol. It is necessary to continue medical training.
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Affiliation(s)
- M-L Langlais
- Urgences médicales adultes Cavale Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - M Dargère
- Urgences médicales adultes Cavale Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - C Le Niger
- Unité d'hémovigilance, hôpital Morvan, CHRU de Brest, 5, avenue Foch, 29609 Brest, France.
| | - D Goetghebeur
- Urgences médicales adultes Cavale Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
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Meunier T, François A, Poisson J, Gisselbrecht M, Arlet JB, Ducot L, Lahjibi-Paulet H, Le Guen J, Mercadier E, Pouchot J, Saint Jean O. [Blood management in geriatric hospitalized population]. Rev Med Interne 2018; 39:84-9. [PMID: 29279179 DOI: 10.1016/j.revmed.2017.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/10/2017] [Accepted: 11/25/2017] [Indexed: 01/28/2023]
Abstract
INTRODUCTION In France, nearly 50% of patients transfused in packed red blood cells are 75 or older. The benefit of restrictive transfusion policies is no longer to be demonstrated, but the practices are still far from it. The objective of our study was to show the impact of a decision support tool on transfusion practices, specifically in a hospitalized elderly population. METHOD A clinical decision support, validated in the improvement of practices, was created, based on the latest transfusion recommendations of 2014. Our study was interventional, monocentric, within the departments of internal medicine and geriatrics of a university hospital from February to July 2016. The clinical decision support was available for any request of transfusion of packed red blood cells for 75 years old or older patient who was hospitalized in one of these two services. RESULTS There were 134 transfusions out of 173 for which the prescriber used our tool. Comparing 2016 with the previous two years, our tool decreased the rate of packed red blood cells delivered by 11% compared to 2014 (P<0.005), but there was no significant difference compared to 2015. It has also reduced the transfusion rate of multi-unit transfusions by 35% compared with 2014 and by 29% compared with 2015 (P<0.005). CONCLUSION Our tool, applied specifically to the elderly, is useful to improve transfusion practices and requires to be validated on a larger scale.
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20
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Bakrim S, Ouarour A, Jaidann K, Benajiba M, Masrar A. [Hemogram profile and interest of pre-donation hemoglobin measurement in blood donors in the northwest region of Morocco]. Transfus Clin Biol 2017; 25:35-43. [PMID: 29146407 DOI: 10.1016/j.tracli.2017.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Blood donation in Morocco and more particularly in the northwest region is carried out without prior determination of the pre-donation hemoglobin. In addition, we note the lack of scientific research that reports data on the red blood cells, leukocytes and platelet lines in donated blood at the regional or even national level. AIMS To study hemogram profile in blood donors taken from the Northwest region of Morocco in order to provide decision makers of the National Center of Blood Transfusion and Hematology with valid scientific arguments to complete the criteria to donate whole blood, by the hemogram. METHODS Prospective study, conducted in 15797 volunteer blood donors (BD) aged between 18 and 60 years, collected during mobile or fixed collections carried out by the Regional Blood Transfusion Center of Tangier and Tetouan from November 2014 to May 2016. The hemogram was performed using a Sysmex KX21N® and the analysis of the data was done by the software SPSS 20.0. RESULTS According to the World Health Organization, anemia corresponds to a hemoglobin level less than 12g/dL in women and less than 13g/dL in men. We found that 14.5 % of women (n=1054) and 3.0 % of men (n=245) were anemic and anemia was hypochromic microcytic in 58,66 % of these BD. Analysis of the white line showed leucopenia in 2.05 % of BD and 807 cases of leukocytosis (5.27 % of BD). Platelet study showed thrombocytopenia in 3.97 % of BD and thrombocytosis in 151BD (0.99 % of cases). CONCLUSION This study shows the interest of systematic pre-donation hemoglobin measurement and periodic realization of the hemogram among BD in the Northwest region of Morocco.
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Affiliation(s)
- S Bakrim
- Laboratoire de biologie et santé, université Abdelmalek-Essaâdi, faculté des sciences, BP 2121, Tétouan, Maroc; Laboratoire d'hématologie, centre hospitalier provincial, hôpital Mohammed-VI, M'diq 93200, Maroc; Laboratoire d'hématologie, faculté de médecine et de pharmacie, université Mohammed-V, Rabat, Maroc; Laboratoire central d'hématologie, centre hospitalier Ibn-Sina, Rabat, Maroc.
| | - A Ouarour
- Laboratoire de biologie et santé, université Abdelmalek-Essaâdi, faculté des sciences, BP 2121, Tétouan, Maroc
| | - K Jaidann
- Centre régional de transfusion sanguine (CRTS), Tétouan, Maroc
| | - M Benajiba
- Centre national de transfusion sanguine et d'hématologie (CNTSH), Rabat, Maroc
| | - A Masrar
- Laboratoire d'hématologie, faculté de médecine et de pharmacie, université Mohammed-V, Rabat, Maroc; Laboratoire central d'hématologie, centre hospitalier Ibn-Sina, Rabat, Maroc
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21
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Mahmoudi R, Novella JL, Jaïdi Y. [Transfusion in elderly: Take account frailty]. Transfus Clin Biol 2017; 24:200-208. [PMID: 28690038 DOI: 10.1016/j.tracli.2017.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Abstract
The conjunction of the demographic aging and the increase in the frequency of anemia with the advancing age, mean that the number of globular concentrates delivered each year increases with a consequent heavy pressure on blood collection. The etiologies of anemia in the elderly are often multifactorial and their investigation is an indispensable step and prior to any treatment. Transfusion thresholds, particularly in the elderly, are gradually evolving and a so-called restrictive strategy is now favored. Immediate and delayed complications of transfusion are more frequent in the elderly due to vulnerability factors associated with frailty and the risk of multiple transfusions. The screening of complications related to transfusion of RBCs is essential and makes it possible to avoid their recurrence. The impact of transfusion on the quality of life of elderly patients is not obvious and is a controversial issue. In addition, transfusion of red blood cells (RBCs) is accompanied by an increase in health expenditure and an increase in morbidity and mortality, whose risks can be reduced through alternatives to transfusion. Longitudinal studies, including elderly subjects, would allow a better understanding of the issues involved in the transfusion of RBCs in this population.
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Affiliation(s)
- R Mahmoudi
- Service de médecine interne et gériatrie aiguë, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; EA 3797, faculté de médecine, université de Reims Champagne Ardenne, 51092 Reims cedex, France.
| | - J-L Novella
- Service de médecine interne et gériatrie aiguë, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; EA 3797, faculté de médecine, université de Reims Champagne Ardenne, 51092 Reims cedex, France
| | - Y Jaïdi
- Service de médecine interne et gériatrie aiguë, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; EA 3797, faculté de médecine, université de Reims Champagne Ardenne, 51092 Reims cedex, France
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Yao KH, Tanon AK, Lagou AD, Konan SD, Diopoh SP, Meite F. [Comparative study of community acute kidney injury in HIV infected versus non-infected persons: Experience of an internal medicine department in Abidjan (Côte d'Ivoire)]. Nephrol Ther 2017; 13:168-175. [PMID: 28462877 DOI: 10.1016/j.nephro.2016.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/23/2016] [Accepted: 10/03/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is commonly associated with HIV infection. OBJECTIVES To describe the profile of AKI in HIV infected versus non-infected persons. PATIENTS AND METHODS This is a prospective study that was carried out during the study period from January 2010 to December 2015 in the department of nephrology-internal medicine D of Treichville University Hospital (Côte d'Ivoire). RESULTS The prevalence of HIV infection was 35.2% in the population of AKI. The average age of patients was 42±18 years in the HIV positive group against 51±18 years in the HIV negative group (P=0.0001). Etiologies were infections in 65.1% in the HIV positive group against 38.8% in the HIV negative group (P=0.0001) and water loss in 24.7% in the HIV positive group against 7.8% in the HIV negative group (P=0.0001). Factors such as the AIDS stage (P=0.002), severe sepsis (P=0.002) and acute pyelonephritis (P=0.001) were associated with mortality in HIV positive patients against severe anemia (P=0.0001) and severe sepsis (P=0.0001) in the HIV-negative group. CONCLUSION HIV positive patients are younger with a female predominance. The mortality rate is identical in both groups.
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Affiliation(s)
- Kouamé Hubert Yao
- Service de néphrologie-médecine interne, CHU Treichville, BP V3 Abidjan 01, Abidjan, Cote d'Ivoire.
| | - Aristophane Koffi Tanon
- Service des maladies infectieuses et tropicales, CHU Treichville, BP V3 Abidjan 01, Abidjan, Cote d'Ivoire
| | | | - Serge Didier Konan
- Service de néphrologie-médecine interne, CHU Treichville, BP V3 Abidjan 01, Abidjan, Cote d'Ivoire
| | - Séry Patrick Diopoh
- Service de néphrologie-médecine interne, CHU Treichville, BP V3 Abidjan 01, Abidjan, Cote d'Ivoire
| | - Fatou Meite
- Service de néphrologie-médecine interne, CHU Treichville, BP V3 Abidjan 01, Abidjan, Cote d'Ivoire
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Ozier Y, Aubron C, Nguyen BV. [Hospital-acquired anemia: Facts, consequences and prevention]. Transfus Clin Biol 2016; 23:185-91. [PMID: 27562519 DOI: 10.1016/j.tracli.2016.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 12/31/2022]
Abstract
Hospital-acquired anemia is common, especially in the most critically ill patients. It may be associated with poor patient outcomes. It may result from increased blood loss, impaired red cell production or reduced red cell life span. Multiple associated factors may contribute simultaneously or sequentially to the decrease in hemoglobin level. Some of them are related to the underlying disease and others are iatrogenic. Clinicians should be aware of the importance and consequences of iatrogenic anemia caused by diagnostic blood sampling. Strategies and measures to minimize iatrogenic blood loss should be prioritized. They may reduce the risk of developing anemia and then red blood cells transfusion requirement.
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Menou A, Pain M, Pivette J, Chenivesse C, Magnan A, Chambellan A. [Importance of comorbidities in the anemia of COPD: Economic implications and 3-year survival analysis]. Rev Mal Respir 2016; 33:565-72. [PMID: 26803449 DOI: 10.1016/j.rmr.2015.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/24/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Anemia occurs commonly in COPD and is associated with a poor prognosis. The role of comorbidities in this is suspected but poorly characterized and the economic implications of anemia combined with COPD in France have not been studied. The healthcare resource utilization and cost impact of anemia remain to be investigated. METHODS One hundred and fifty-one COPD patients attending a pulmonology outpatient department during a 6 months period were retrospectively selected if they had undergone a pulmonary function test, a blood gas analysis or a blood count. The Charlson comorbidity index, resource utilization and economic data from the year before the diagnosis of anemia were compared between anemic and non-anemic patients as well as 3-year survival analysis. RESULTS The prevalence of anemia was 18.5% and was not influenced by GOLD stage. The identification of anemia was similar from blood gas results and full blood count analysis. Comorbidities - mainly cardiovascular - were found in 86% of the anemic patients. The Charlson index was 5.4±2 in the anemic group compared to 4.1±1.5 in the non-anemic group (P<0.01). The Charlson index was the only predictive factor of anemia using logistic regression analysis. The 3-year mortality was 36% in the anemic versus 7% in the non-anemic group (P<0.05). The main factor identified which predicted 3-year mortality was the presence of anemia using logistic regression. Healthcare costs the year prior to the diagnosis of anemia were not significantly different between groups, but there was a tendency to an increase in the cost of the hospitalizations in the anemic group. CONCLUSIONS Anemia is easy to diagnose in COPD from the blood gas analysis. It is frequently linked to the presence of comorbidities - mainly cardiovascular diseases - and is the more important predictive factor of the 3-year mortality. There was a tendency towards an increase in the costs of hospitalizations in anemic patients but this remains to be confirmed in a larger economic study.
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Affiliation(s)
- A Menou
- Université de Nantes, 44000 Nantes, France; L'institut du thorax, Inserm UMR1087, 44000 Nantes, France
| | - M Pain
- Université de Nantes, 44000 Nantes, France; L'institut du thorax, Inserm UMR1087, 44000 Nantes, France
| | - J Pivette
- Caisse régionale d'assurance maladie, 44000 Nantes, France
| | - C Chenivesse
- Service de pneumologie, groupement hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - A Magnan
- Université de Nantes, 44000 Nantes, France; L'institut du thorax, Inserm UMR1087, 44000 Nantes, France; Service de pneumologie, l'institut du thorax, CHU de Nantes, 44000 Nantes, France
| | - A Chambellan
- Université de Nantes, 44000 Nantes, France; L'institut du thorax, Inserm UMR1087, 44000 Nantes, France; Explorations fonctionnelles, CHU de Nantes, 44000 Nantes, France.
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Maazoun F, Gellen Dautremer J, Boutekadjirt A, Pissard S, Habibi A, Bachir D, Rahmouni A, Bartolucci P, Debbache K, Lagrange JL, Michel M, Galacteros F. [Symptomatic extramedullary haematopoiesis in β-thalassemia: A retrospective single centre study]. Rev Med Interne 2015; 37:5-12. [PMID: 26410419 DOI: 10.1016/j.revmed.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 06/03/2015] [Accepted: 07/25/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Symptomatic extramedullary hematopoiesis (EH) is a rare but potentially severe phenomenon which occurs in β-thalassemia. There are no treatment guidelines. METHODS Retrospective single centre study including the cases of symptomatic EH encountered between 1997 and 2014 in a unit specialised in red blood cell genetic disorders. Description of clinical, biological and radiological characteristics of the patients, treatments received, and outcomes. RESULTS Among 182 β-thalassemia patients followed during the study period, 7 cases of symptomatic EH were diagnosed. They were 5 men and 2 women, and their mean age was 37 years. Four patients were splenectomised, two patients were regularly transfused, and four patients had already received erythropoietin. EH was localised in intravertebral areas and responsible for dorsal spinal cord compression in 5 patients, in paravertebral dorsal area in 1 patient, and in presacral area in 1 patient. The mean hemoglobin level at diagnosis was 7.9 g/dL. Treatment administered included: red cell transfusion in 6 cases, associated with hydroxyurea in 5 cases and/or radiotherapy in 3 patients. One patient was treated with surgery and HU. After a median follow-up of 41 months, clinical recovery was complete in 2 patients and partial in 5 patients. CONCLUSION EH must be suspected in β-thalassemia in patients presenting clinical signs of organ compression, and a typical radiological aspect. The functional prognosis depends on the rapidity of treatment, which includes red blood cell transfusion, hydroxyurea, radiotherapy, and rarely surgery. Long-term outcome is uncertain.
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Affiliation(s)
- F Maazoun
- Unité des maladies génétiques du globule rouge, hôpital Henri-Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94110 Créteil cedex, France
| | - J Gellen Dautremer
- Unité des maladies génétiques du globule rouge, hôpital Henri-Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94110 Créteil cedex, France; Service de médecine interne, hôpital Henri-Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94110 Créteil cedex, France.
| | - A Boutekadjirt
- Service d'imagerie médicale, hôpital Henri-Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94110 Créteil cedex, France
| | - S Pissard
- Service de biochimie-génétique, hôpital Henri-Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94110 Créteil cedex, France
| | - A Habibi
- Unité des maladies génétiques du globule rouge, hôpital Henri-Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94110 Créteil cedex, France
| | - D Bachir
- Unité des maladies génétiques du globule rouge, hôpital Henri-Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94110 Créteil cedex, France
| | - A Rahmouni
- Service d'imagerie médicale, hôpital Henri-Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94110 Créteil cedex, France
| | - P Bartolucci
- Unité des maladies génétiques du globule rouge, hôpital Henri-Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94110 Créteil cedex, France; Service de médecine interne, hôpital Henri-Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94110 Créteil cedex, France
| | - K Debbache
- Unité des maladies génétiques du globule rouge, hôpital Henri-Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94110 Créteil cedex, France
| | - J-L Lagrange
- Service de radiothérapie, hôpital Henri-Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94110 Créteil cedex, France
| | - M Michel
- Service de médecine interne, hôpital Henri-Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94110 Créteil cedex, France
| | - F Galacteros
- Unité des maladies génétiques du globule rouge, hôpital Henri-Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94110 Créteil cedex, France
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Ogier M, Kerjouan M, Libessart T, Merzoug A, Leroyer C, Desrues B, Jouneau S. [Posterior mediastinal mass]. Rev Mal Respir 2015; 32:959-62. [PMID: 26232209 DOI: 10.1016/j.rmr.2015.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Affiliation(s)
- M Ogier
- EA 3149, EA 3878 (GETBO), IFR 148, département de médecine interne et de pneumologie, université européenne de Bretagne, CHU de La Cavale-Blanche, 29609 Brest, France; Service de pneumologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France.
| | - M Kerjouan
- Service de pneumologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France
| | - T Libessart
- Service de radiologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France
| | - A Merzoug
- Service de pneumologie, centre hospitalier de Fougères, 133, rue de la Forêt, 35300 Fougères, France
| | - C Leroyer
- EA 3149, EA 3878 (GETBO), IFR 148, département de médecine interne et de pneumologie, université européenne de Bretagne, CHU de La Cavale-Blanche, 29609 Brest, France
| | - B Desrues
- Service de pneumologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France
| | - S Jouneau
- Service de pneumologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France; IRSET UMR 1085, université de Rennes 1, 35043 Rennes, France
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Rieger J, Krummel T, Petitjean P, Chantrel F, Dimitrov Y. [Switch of methoxy-polyethylene-glycol-epoetin beta to darbepoetin alfa in 263 dialysis patients]. Ann Pharm Fr 2015; 74:45-8. [PMID: 26194063 DOI: 10.1016/j.pharma.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
In early 2012, due to national supply disruption, the methoxy-polyethylene glycol-epoetin beta (CERA) was no longer available and has been replaced by darbepoetin alfa (DA) in all dialysis patients. Official recommendations for the replacement of one by the other is missing or unclear. On this occasion, we wanted to examine how the shift from CERA to DA was done in terms of dose conversion factor and the other factors that could have influenced the dose of DA prescribed (hemoglobin, patient weight, dose of CERA). This retrospective multicenter open conducted in six dialysis centers in Alsace is the first large study (n=263) that evaluated the switch from CERA to DA in all chronic hemodialysis patients. We found that the instantaneous ratio of dose adjustment is close to 1 and that nephrologists are mainly based on the dose of CERA for determining the DA dose, before hemoglobin and weight. However, establishing a true dose-response ratio between the two molecules requires a long term prospective study.
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Affiliation(s)
- J Rieger
- Service de pharmacie-stérilisation, centre hospitalier de Haguenau, 64, avenue du Professeur-Leriche, 67500 Haguenau, France
| | - T Krummel
- Service de néphrologie, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - P Petitjean
- Service de néphrologie, clinique St-Anne, rue Philippe-Thyss, 67000 Strasbourg, France
| | - F Chantrel
- Service de néphrologie, hôpital Edouard-Muller, 20, avenue du Dr-Laennec, 68070 Mulhouse, France
| | - Y Dimitrov
- Service de néphrologie, centre hospitalier de Haguenau, 64, avenue du Professeur-Leriche, 67500 Haguenau, France.
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Tiotiu A, Clément-Duchêne C, Martinet Y. [Management of chemotherapy-induced anemia in lung cancer]. Rev Mal Respir 2015; 32:809-21. [PMID: 26051503 DOI: 10.1016/j.rmr.2014.10.734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 10/19/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The prevalence of chemotherapy-induced anemia in lung cancer is estimated at about 80%. STATE OF ART There are currently no specific recommendations for the management of chemotherapy-induced anemia in lung cancer. In this paper, we propose a synthesis of currently existing data in the literature on the management of chemotherapy-induced anemia in general, supplemented with specific data about the efficacy and safety of erythropoietic therapy in lung cancer. PERSPECTIVES Better management of chemotherapy-induced anemia improves patient's quality of life and reduces red blood cell transfusion requirement. In the meantime, in respect to currently missing data, thoracic oncologists should develop specific recommendations for the management of chemotherapy-induced anemia in lung cancer, with specific studies in this domain. CONCLUSIONS Since the prevalence of chemotherapy-induced anemia in patients with lung cancer is high and has a significant impact on these patients quality of life, a specific prospective management should be implemented as early as possible.
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Affiliation(s)
- A Tiotiu
- Département de pneumologie, CHU de Nancy, 9, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - C Clément-Duchêne
- Département de pneumologie, CHU de Nancy, 9, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - Y Martinet
- Département de pneumologie, CHU de Nancy, 9, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
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Abstract
It is well recognized that anaemia, a frequent complication of critical illness, is associated with poor outcomes, perhaps particularly in patients with ischaemic heart disease. But studies have also reported increased morbidity and mortality in patients who receive blood transfusions. So which carries the biggest risk, when should we transfuse and when should we hold off? Should we have fixed transfusion triggers and if so in all patients, or different triggers for different groups of patients? Indeed, these are more complex decisions than initially apparent. ICU patients are very heterogeneous and will react differently to the same intervention. As such, decisions to transfuse or not must be individualized, taking into account specific patient factors, such as age and comorbidities, physiologic variables, as well as the haemoglobin value. This approach will ensure that anaemia is treated when necessary while avoiding unnecessary exposure to red blood cells.
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Trinh THC, Fleury M, Leo-Kodeli S, Gauvain JB. [Indicators of transfusion decision in acute geriatric ward with an exclusive emergency room recruitment]. Transfus Clin Biol 2015; 22:42-8. [PMID: 25649535 DOI: 10.1016/j.tracli.2014.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/16/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Description of the transfusion practice and its specificities in a geriatric unit. PATIENTS AND METHODS Prospective descriptive study realized by a single consultant. INCLUSION CRITERIA patients admitted in the unit between 01/10/2011 and 31/01/2012 with hemoglobin level below 10 g/dL. RESULTS Eighty-one patients: 87.7-year-old±5.6, ADL 2.1±1.9. CIRS 15.5±3.9. Forty-five (55.5%) of the patients received blood transfusion. Cause of admittance: anemia for 9% of patients. The etiology of anemia was multifactorial in the majority of cases. Admission hemoglobin rate: 9.1 g/dL±1.1 in transfused group versus 9.6 g/dL±0.5 for non-transfused patients. The clinical signs of anemia were asthenia (98.8%), impact on everyday activities (91.4%), respiratory distress (60.5%), stability disturbances and falls (38.3%), confusion (32.1%), hemodynamic disorders (29.6%). The increase of hemoglobin rate was 1.45 g/dL in the transfused group versus 0.3 g/dL for the non-transfused patients. A side effect was observed in 2 transfused patients (4.4%). DISCUSSION Transfusion decision criteria are rarely studied in geriatrics. The clinical signs of anemia include the classical hemodynamic disorders, cardio-respiratory and more specific of the elderly patients as confusion, majoring of cognitive decline and falls. The transfusion threshold (1.4 g/dL per 1 RBC unit) seems higher than in the overall transfused patients. Transfusion remains the fastest way to correct anemia but exposes to circulatory overload.
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Affiliation(s)
- T H C Trinh
- Service de médecine aiguë gériatrique, centre hospitalier régional d'Orléans, hôpital de la Source, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France.
| | - M Fleury
- Service de médecine aiguë gériatrique, centre hospitalier régional d'Orléans, hôpital de la Source, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France
| | - S Leo-Kodeli
- Unité de sécurité transfusionnelle et d'hémovigilance, centre hospitalier régional d'Orléans, hôpital de la Source, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France
| | - J-B Gauvain
- Service de médecine aiguë gériatrique, centre hospitalier régional d'Orléans, hôpital de la Source, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France
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Gacon PH, Jourdain P, Heba N, Amara W. [Acute atrio-ventricular block in sickle cell anemia]. Ann Cardiol Angeiol (Paris) 2014; 63:321-6. [PMID: 25266160 DOI: 10.1016/j.ancard.2014.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 08/24/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Even though sickle cell disease has a high prevalence amongst the black race and despite its well known potential of micro infarction, there have been only a few reports regarding the acute myocardial damage during vaso-occlusive crisis. The risk of atrio ventricular block during these crises has never been described in a large survey. PATIENTS AND RESULTS Ten patients (six men and four women, mean age 39 years old) were hospitalized for an acute atrio ventricular block. The patients were all African or Caribbean natives. Three patients were found with a heterozygous phenotype for hemoglobin S (sickle trait) and seven were found with a homozygous phenotype. The most common symptoms were asthenia (10 cases), shortness of breath (8 cases) and acute coronary syndrome (1 case) (syncope was not reported). Four patients had a second degree atrio ventricular block and six patients had third degree block. The treatment involved bed rest, intravenous hydration, and pain relief with opiates. All the cases of atrio ventricular block were only transitory and none of the patients underwent a pacemaker implantation. CONCLUSION This report is the largest survey regarding transitory acute atrio ventricular block in patients with sickle cell disease. A local ischemic event affecting the AV node and Hiss bundle area can explain the conduction abnormalities. Sickle cell disease must be ruled out in black patients with an AV block.
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Debras E, Revaux A, Bricou A, Laas E, Tigaizin A, Benbara A, Carbillon L. [Obstetric and neonatal outcomes of adolescent pregnancies: a cohort study in a hospital in Seine-Saint-Denis France]. ACTA ACUST UNITED AC 2014; 42:579-84. [PMID: 24996878 DOI: 10.1016/j.gyobfe.2014.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 04/03/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study was to describe the characteristics, monitoring, obstetrical complications, childbirth and neonatal outcomes of pregnancies among minors in a cohort of adolescents from Seine-Saint-Denis (France). PATIENTS AND METHODS This is a retrospective, cohort, comparative study, conducted from January 1, 1996 to July 31, 2011, made from the database of Jean-Verdier hospital in Seine-Saint-Denis. Three groups were established: patients aged less than 16 years old, patients aged over 16 years old and under 18 years old compared to a group consisting of older primiparas from 18 to 25 years old. The criteria considered were the characteristics of pregnancy, terms of delivery, neonatal outcome and conduct of post-partum. RESULTS Minor patients were statistically more likely to be single, student, smoking and anemia compared to young adults. The obstetrical care was lower for minor compared to the control group with a number of consultations and ultrasounds lower (P < 0.001). Obstetrical complications were similar in the three groups outside of preterm labor. Adolescentes under 16 years old had a higher preterm delivery risk in multivariate analysis (RR = 0.33 CI 95% [0.12; 0.90] P = 0.03). Adolescents had fewer cesarean and instrumental deliveries (P < 0.05). DISCUSSION AND CONCLUSION Teenage pregnancy remains an important managing issue for maternities, particularly from a social standpoint. On the medical side, one preterm delivery appears to be more common among these adolescents.
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Affiliation(s)
- E Debras
- Service de gynécologie obstétrique, université Paris 13, hôpital Jean-Verdier, Assistance Publique-Hôpitaux de Paris, avenue du 14-juillet, 93140 Bondy, France
| | - A Revaux
- Service de gynécologie obstétrique, université Paris 13, hôpital Jean-Verdier, Assistance Publique-Hôpitaux de Paris, avenue du 14-juillet, 93140 Bondy, France.
| | - A Bricou
- Service de gynécologie obstétrique, université Paris 13, hôpital Jean-Verdier, Assistance Publique-Hôpitaux de Paris, avenue du 14-juillet, 93140 Bondy, France
| | - E Laas
- Service de gynécologie obstétrique, université Paris 6, hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
| | - A Tigaizin
- Service de gynécologie obstétrique, université Paris 13, hôpital Jean-Verdier, Assistance Publique-Hôpitaux de Paris, avenue du 14-juillet, 93140 Bondy, France
| | - A Benbara
- Service de gynécologie obstétrique, université Paris 13, hôpital Jean-Verdier, Assistance Publique-Hôpitaux de Paris, avenue du 14-juillet, 93140 Bondy, France
| | - L Carbillon
- Service de gynécologie obstétrique, université Paris 13, hôpital Jean-Verdier, Assistance Publique-Hôpitaux de Paris, avenue du 14-juillet, 93140 Bondy, France
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Rottembourg J, Sonigo Y, Dansaert A, Diaconita M, Guerin A. [Intravenous iron during predialysis period improves anemia management and cardiovascular parameters in incident hemodialysis patients]. Nephrol Ther 2013; 9:486-93. [PMID: 24113201 DOI: 10.1016/j.nephro.2013.07.364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 07/12/2013] [Accepted: 07/16/2013] [Indexed: 11/26/2022]
Abstract
Individualized use of iron therapy (IT) and erythropoiesis-stimulating agents (ESA) may effectively correct anemia and its symptoms in CKD patients (Pts). The aim of this retrospective study was to precise the anemia management (AM) in incident HD Pts, and to compare Pts treated by intravenous (i.v.) IT and ESA during predialysis to those treated by oral IT and ESA on AM and cardiovascular parameters during the first year of HD. One hundred and two Pts performed their first dialysis in the unit, mean age 58.5 (15.9) years, 70% males, 27% diabetes. Ninety Pts started with a native arteriovenous fistula. Charlson comorbidity index was 7.3 (3.5). Mortality rate was 3% at one year. Hb level was at start 10.6 (1.7) and at one year 11.7 (1.1) g/dL (P<0.0001). DA injected every 2weeks was at the beginning at 107 (56) μg and then at 61 (46) (P<0.0001). i.v. IT injected every week was at the dosage of 87 (23) mg and then at 57 (40mg) per injection (P<0.001). Out of 102 Pts, 33 received i.v. IT during predialysis. These Pts started dialysis with a better Hb level: 11.1 (1.3) versus 10.4 (1.55) g/dL (P<0.01), had a TSAT at 50.0 (19.2) versus 30.1 (15.2) % (P<0.001), received less ESA 0.58 (0.28) versus 0.82 (0.37) μg/kg per week (P<0.01). More important were the changes on the cardiovascular functions: left ventricular mass at 116 (34) versus 134 (39) g/m(2) (P<0.02), left ventricular ejection fraction at 64.7 (4.4) versus 61.4 (8.7) % (P<0.02) and mean arterial pressure at 104.7 (80) versus 109 (13.2) mmHg (P<0.02). These Pts were also less hospitalized. This study revealed the importance of i.v. IT during predialysis care not only on AM but also on cardiovascular status in HD Pts starting dialysis.
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Ennezat PV, Maréchaux S, Pinçon C, Finzi J, Barrailler S, Bouabdallaoui N, Van Belle E, Montalescot G, Collet JP. Anaemia to predict outcome in patients with acute coronary syndromes. Arch Cardiovasc Dis 2013; 106:357-65. [PMID: 23806304 DOI: 10.1016/j.acvd.2013.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 02/13/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Owing to the heterogeneous population of patients with acute coronary syndromes (ACS), risk stratification with tools such as the GRACE risk score is recommended to guide therapeutic management and improve outcome. AIM To evaluate whether anaemia refines the value of the GRACE risk model to predict midterm outcome after an ACS. METHODS A prospective registry of 1064 ACS patients (63 ± 14 years; 73% men; 57% ST-segment elevation myocardial infarction [MI]) was studied. Anaemia was defined as haemoglobin less than 13 mg/dL in men or less than 12 mg/dL in women. The primary endpoint was 6-month death or rehospitalization for MI. RESULTS The primary endpoint was reached in 132 patients, including 68 deaths. Anaemia was associated with adverse clinical outcomes (hazard ratio 3.008, 95% confidence interval 2.137-4.234; P<0.0001) in univariate analysis and remained independently associated with outcome after adjustment for the Global Registry of Acute Coronary Events (GRACE) risk score (hazard ratio 2.870, 95% confidence interval 1.815-4.538; P<0.0001). Anaemia provided additional prognostic information to the GRACE score as demonstrated by a systematic improvement in global model fit and discrimination (c-statistic increasing from 0.633 [0.571;0.696] to 0.697 [0.638;0.755]). Subsequently, adding anaemia to the GRACE score led to reclassification of 595 patients into different risk categories; 16.5% patients at low risk (≤ 5% risk of death or rehospitalization for MI) were upgraded to intermediate (>5-10%) or high risk (>10%); 79.5% patients at intermediate risk were reclassified as low (55%) or high risk (24%); and 45.5% patients at high risk were downgraded to intermediate risk. Overall, 174 patients were reclassified into a higher risk category (17.3%) and 421 into a lower risk category (41.9%). CONCLUSION Anaemia provides independent additional prognostic information to the GRACE score. Combining anaemia with the GRACE score refines its predictive value, which often overestimates the risk.
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Affiliation(s)
- Pierre Vladimir Ennezat
- Cardiology Intensive Care Unit, CHRU Lille and Institut Fédératif de Recherche 114, EA 2693, Université de Lille 2UDSL, France.
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Sterpu R, Ichou H, Mahé I, Mortier E. [Reactivation of parvovirus B19 infection in an HIV-infected woman]. Rev Med Interne 2013; 35:396-8. [PMID: 23791089 DOI: 10.1016/j.revmed.2013.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/30/2013] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Infection by human parvovirus B19 (erythrovirus B19) is common and usually asymptomatic during childhood conferring lasting protection against a new infection. Parvovirus B19 infection may cause erythema infectiosum (5th disease) and aplastic crisis. Secondary symptomatic parvovirus B19 infection in the same patient is rare and its physiopathology is not always clear. CASE REPORT A 48-year-old HIV-infected female patient presented within 5 years two acute episodes of parvovirus B19 infection although her CD4 cells count was above 500/mm(3). Absence of specific antibodies production after the first episode and persisting parvovirus viremia suggested viral reactivation rather than re-infection. During the second episode, specific antibodies were produced. CONCLUSION Similarly to most DNA viruses, parvovirus B19 reactivation is possible in HIV-infected patients while effectively treated by antiretroviral therapy.
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Affiliation(s)
- R Sterpu
- Service de médecine interne, hôpital Louis-Mourier (AP-HP), 178, rue des Renouillers, 92700 Colombes, France
| | - H Ichou
- Service de microbiologie, hôpital Louis-Mourier (AP-HP), 178, rue des Renouillers, 92700 Colombes, France
| | - I Mahé
- Service de médecine interne, hôpital Louis-Mourier (AP-HP), 178, rue des Renouillers, 92700 Colombes, France
| | - E Mortier
- Service de médecine interne, hôpital Louis-Mourier (AP-HP), 178, rue des Renouillers, 92700 Colombes, France.
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