Impact of anaemia on acute stroke outcomes depends on the type of anaemia: Evidence from a UK stroke register

Background: Previous research has demonstrated an association between anaemia and poor outcomes in acute stroke. This study aimed to assess the impact of anaemia on stroke by anaemia subtype. Methods: Data from a prospective UK Regional Stroke Register were used to assess the association between hypochromic microcytic and normochromic normocytic anaemia on inpatient-mortality, length of stay (LOS) and discharge modified Rankin scale (mRS). Analysis was stratified by stroke subtypes and multivariable logistic regression, adjusting for potential confounders, was used to quantify this association. Patients who were not anaemic were the reference category. Results: A total of 8167 stroke patients (admitted between 2003 and 2015) were included, mean age (SD) 77.39 ± 11.90 years. Of these, 3.4% (n = 281) had hypochromic microcytic anaemia and 15.5% (n = 1262) had normochromic normocytic anaemia on admission. Normochromic normocytic anaemia was associated with increased odds of in-patient mortality OR 1.48 (1.24–1.77), 90-day mortality OR 1.63 (1.38–1.92), longer LOS OR 1.21 (1.06–1.40), defined as > 7 days, and severe disability defined as discharge mRS ≥ 3 OR 1.31 (1.06–1.63), in patients with ischaemic stroke. Hypochromic microcytic anaemia was associated with 90-day mortality OR 1.90 (1.40–2.58) and a longer LOS OR 1.57 (1.20–2.05) in patients with ischaemic stroke. Conclusions: Hypochromic microcytic and normochromic normocytic anaemia are associated with differing outcomes in terms of inpatient mortality and post stroke disability. While it is unclear if anaemia per se or another underlying cause is responsible for adverse outcomes, subtype of anaemia appears to be relevant in stroke prognosis

Profile of Anemia on Lung Tuberculosis at Dr. Hasan Sadikin General Hospital and Community Lung Health Center Bandung

Background: Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis that can cause anemia. Anemia is a lack of erythrocyte mass needed to carry adequate oxygen to the whole bodies. The aim of this study was to describe the anemia in adult lung TB patients at Dr. Hasan Sadikin General Hospital and Community Lung Health Center (Balai Kesehatan Paru Masyarakat, BKPM) Bandung.Methods: This descriptive study was conducted from August to October 2014. Study subjects were adult TB patients who came for their first control to TB Clinic Dr. Hasan Sadikin General Hospital and BKPM Bandung after receiving oral antituberculosis drugs, and willing to comply in study. The exclusion criteria were patients with other chronic diseases, pregnant, menorrhagia, and hemoptoe. Three mL of vein blood was taken and put into EDTA tube for routine hematologic measurement using automatic hematologic analyzer, sysmex KX-21®.Results: There was 31 (63.26%) from 49 adult lung TB patients suffered anemia. In male subjects, mild and moderate anemia were found 57.14% and 42.86% respectively, and in female subjects were 58.82% and 41.18% respectively. In males, there were 42.86% normochromic normocytic, 42.86% hypochromic microcytic, 7.14% normochromic microcytic, and 7.14% hypochromic normocytic, while in females, there were 5.88% normochromic normocytic, 47.06% hypochromic microcytic, 17.65% normochromic microcytic, 29.41% hypochromic normocytic.Conclusions: Anemia is found in 63.26% adult lung TB patients, most of which are mild anemia and hypochromic microcytic, especially in female subjects. [AMJ.2016;3(1):137–40] DOI: 10.15850/amj.v3n1.47

Three-Month Iron Supplementation as Treatment for Microcytic Hypochromic Anemia in Pregnancy

In pregnant women there is a twofold increase in iron requirements due to increased blood volume without the expansion of plasma volume. Pregnant women are very prone to suffering from iron deficiency anemia. Iron deficiency anemia generally has an erythrocyte index which represents  hypochromic microcytic. This study aimed to determine the effect of three-month iron tablet supplementation as a therapy against microcytic hypochromic anemia in pregnancy. This was a quantitative quasi-experimental study using pre-test and post-test design. The study was conducted in May-September 2020 at the Arifin Achmad Regional General Hospital, Riau Province, Indonesia. Subjects were 30 pregnant women with microcytic hypochromic anemia. Primary data were analyzed using statistical paired sample t-tests. Results showed that there was an increase in hemoglobin levels after the supplementation of iron tablet from an average of 9.1 ± 1.2 gr/dl to 11.8 ± 1.0 g/dl. This change was significant based on the results of the T-test (p-0.003) Thus, iron supplementation for three month significantly increases hemoglobin levels in pregnant women

RBC INDICES, PERIPHERAL SMEAR AND PLATELET INDICES CORRELATION FOR MICROCYTIC ANEMIA ASSESSMENT: A CROSS-SECTIONAL STUDY.

Aim The current study aims to explore the relationship among platelet indices, RBC indices and peripheral blood smears in the assessment of microcytic hypochromic anemia.  Methods A cross sectional study was conducted at the Indira Gandhi Institute of Medical Sciences, Patna, Bihar over the duration of a February 2021 to March 2022, which included 4560 cases comprising indoor and outdoor patients. Peripheral blood smear stained with Leishman were made using blood samples obtained in EDTA tubes. Automated cell counters were for analysis of complete blood counts including hemoglobin, RBC indices and other hematological parameters.  Results Among 4560 cases, 51.63% were male and 48.37% were female, and adults in their thirties (19.35%) were the group most affected. The most prevalent morphological type was microcytic hypochromic anemia (48.10%), mostly of intermediate severity (63.47%), affecting females and children. Normocytic normochromic anemia (41.01%) was primarily mild (61.52%) and common among the elderly. Macrocytic anemia (11.54%) showed no significant age or severity variations. Only 4.08% cases had dimorphic anemia, with 63.7% being mild.  Conclusion Anemia's prevalence and severity vary across age groups due to diverse underlying causes. As individuals age progresses, anemia becomes more common, linked to infections, inflammation, chronic diseases, and reduced bone marrow response. Accurate diagnosis and treatment planning require identifying cause, type, and severity of anemia.  Recommendations According to the study, healthcare providers should monitor age-related anemia prevalence and severity. Consider infections, inflammation, chronic illnesses, and diminished bone marrow response when examining patients, especially as they age. To optimize patient outcomes, accurate diagnosis and individualized treatment regimens should focus on anemia etiology, type, and severity

APPLICABILITY OF ADOPTING MORPHOLOGICAL PATTERNS IN PEDIATRIC ANEMIAS AS ETIOLOGICAL INDICATORS

Background: Pediatric anemia is a global phenomenon. The magnitude of this problem gets exaggerated in developing countries like India wherein majority of the population are vulnerable since they live in rural areas and come under low socio-economic status. Though pediatric anemias can be diagnosed by simple blood tests like complete hemogram and peripheral smear examination, the evaluation of underlying etiological factor to initiate appropriate therapy involves expensive work up which may not be affordable in a rural setup. This need-based study of pediatric anemia was conducted to determine the morphological patterns of anemia by simple baseline investigations and to detect the related etiologic factor. Methodology: The probable etiological factors contributing to the anemias were diagnosed by determining the morphological patterns using simple baseline investigations like complete hemogram and peripheral blood examination and treated accordingly. Conclusion: The etiology of microcytic hypochromic anemia was found out to be iron deficiency as confirmed by serum iron profile studies. Presence of dimorphic anemia suggested combined nutritional deficiency of Iron, vitamin B12 deficiency or folate. Hemolytic anemias detected by routine hematological investigations were confirmed by serum electrophoresis. Morphological examination of red blood cells on peripheral smear examination is thus an effective, simple and cost effective method to determine the etiology of various types of anemia. KEYWORDS: Peripheral blood smear examination; Baseline investigation; Patient management

PREVALENCE OF PAANDU (ANAEMIA) AMONGST PATIENTS REPORTING AT OUTPATIENT DEPARTMENT OF NATIONAL INSTITUTE OF SIDDHA

Anaemia is the most common nutritional problem in the world .In the outpatient department of National institute of Siddha the significant numbers of anaemia cases are reporting for treatment. As the part of partial completion of 1st year MD degree the investigator select the minor project to determine the data about prevalence of Paandu (Anaemia) in NIS OPD patients. This study includes 500 OPD patients. OPD patients in the age between 13-74 years were randomly selected daily (Systematic random sampling method). A pre-designed self-administrated questionnaire interview method is used for collecting data about the patients. Information on personal characteristics, socio economic status, diet, lab investigations, clinical profiles are obtained. The study results showed that the prevalence of anemia amongst patients reporting at NIS OPD were 45.6%. The mean haemoglobin concentration was 11.4g/dl in female and 12.8g/dl in male. Majority of female in reproductive age (15-49 years) had the highest prevalence of anemia. And the high proportion of microcytic hypochromic anaemia (22.2%) was founded in the selected samples which indicate that Iron deficiency was the main cause of anaemia. Effect of socio economic status on anemic patients reported in NIS also calculated according to ‘Modified Kuppusamy socio economic scale’ which results that patients belongs to the upper lower status (12.2%) are more prone to anemia. Therefore the results of this study can be used to design target interventions aimed at reducing the prevalence of anemia in NIS OPD and to help conduct the interactive educational programs for improve disease awareness in female patients especially. And further studies are needed for clarify prevalence and etiology of anaemia in school going children (Below 13 years) at NIS OPD

Best Practices for the Prevention and Treatment of Microcytic Hypochromic Anemia in Infancy

Background: Microcytic hypochromic anemia is the most common nutritional deficiency in the world. This type of anemia is commonly found during infancy due to the lack of iron-fortified foods after six months of age. The effects linked to this deficiency can cause developmental delays and behavioral disturbances in infants if not treated immediately. Therefore, it is important for nurses to find the best practices to prevent microcytic hypochromic anemia to decrease its prevalence in infancy. Objective: To find the best nursing practices for the prevention and treatment of microcytic hypochromic anemia in infancy. Methods: This research will utilize a literature review relating to preventative measures for microcytic hypochromic anemia in infants. Findings: The preventative measures for this anemia includes dietary prevention, proper breastfeeding, parental knowledge, and delayed cord clamping. It is important for health care professionals, especially nurses, to give appropriate education on these measures to parents and caregivers in order to decrease the incidence of microcytic hypochromic anemia in infants. Proposal: A quantitative quasi-experimental study will be proposed in order to find the best practices for nurses to prevent and treat microcytic hypochromic anemia during infancy. Keywords: microcytic hypochromic anemia, iron deficiency anemia, infancy, treatment, preventio

APPLICABILITY OF ADOPTING MORPHOLOGICAL PATTERNS IN PEDIATRIC ANEMIAS AS ETIOLOGICAL INDICATORS

Background: Pediatric anemia is a global phenomenon. The magnitude of this problem gets exaggerated in developing countries like India wherein majority of the population are vulnerable since they live in rural areas and come under low socio-economic status. Though pediatric anemias can be diagnosed by simple blood tests like complete hemogram and peripheral smear examination, the evaluation of underlying etiological factor to initiate appropriate therapy involves expensive work up which may not be affordable in a rural setup. This need-based study of pediatric anemia was conducted to determine the morphological patterns of anemia by simple baseline investigations and to detect the related etiologic factor. Methodology: The probable etiological factors contributing to the anemias were diagnosed by determining the morphological patterns using simple baseline investigations like complete hemogram and peripheral blood examination and treated accordingly. Conclusion: The etiology of microcytic hypochromic anemia was found out to be iron deficiency as confirmed by serum iron profile studies. Presence of dimorphic anemia suggested combined nutritional deficiency of Iron, vitamin B12 deficiency or folate. Hemolytic anemias detected by routine hematological investigations were confirmed by serum electrophoresis. Morphological examination of red blood cells on peripheral smear examination is thus an effective, simple and cost effective method to determine the etiology of various types of anemia. KEYWORDS: Peripheral blood smear examination; Baseline investigation; Patient management

Glycosylated Hemoglobin among Non-diabetic Patients Diagnosed as Benign Thyroid Lesions on Cytology: A Cross Sectional Study from a Tertiary Care Centre in India

Background: Hypothyroidism and diabetes usually coexist and are the most common endocrine disorders seen in India (1). Glycosylated Hb (HbA1c) is used for assessment of glycemia and American Diabetic Association (ADA) has recommended its use in diabetes and prediabetes (2). A value between 5.7% and 6.5% represents prediabetes while a value ≥6.5% is considered as diabetes mellitus (3). Glycosylated hemoglobin is a fraction of hemoglobin that undergoes non-enzymatic glycation over the circulatory life span of erythrocytes (4). Several studies have shown glycosylated Hb varies in different conditions like hemoglobinopathies, pregnancy and chronic kidney disease (5).Thyroid hormone plays an important role in glucose homeostasis (6). TSH regulates hematopoiesis in bone marrow (7). Hypothyroidism depresses the marrow which causes decreased erythrocyte production which alters the life span of erythrocytes. Altered life span causes spurious elevation of HbA1C (8, 9, 10). Hence, glycosylated Hb not only depends on glycemia but also on life span of RBC (11). Conditions which effect erythrocyte turnover or survival lead to falsely high or low Hb A1C levels (12). RBC turnover is increased in thyrotoxic states whereas hypothyroidism has the opposite effect (3).In the present study, we hypothesise that glycosylated hemoglobin shows variation in individuals with altered thyroid status. It also aim to establish if a correlation exits between fasting plasma glucose level and hemoglobin with glycosylated hemoglobin in patients with altered thyroid status.Aims and Objectives: To find a correlation between thyroid profile and glycosylated Hb in non-diabetic patients who have been diagnosed on cytology as benign thyroid lesions and Compare the fasting blood glucose and hemoglobin with glycosylated Hb in these patients.Material and Methods: A cross sectional study on 50 cases cytologically diagnosed as benign thyroid lesions in the Department of Pathology in ESIC Medical College and Hospital Faridabad were included in the study with consent of ethical committee.Data Analysis: Pearson’s coefficient was applied to test the association between variables. The significance level was set at 5%.Results: Out of 50 patients (n=25) 50% were hypothyroid, (n=13) 26% were hyperthyroid and (n=12) 24% were euthyroid and (n=22) 88% hypothyroid patients presented with HbA1C >6.5% and were labeled as Diabetic, (n=3) 12% hypothyroid patients were labelled as prediabetic and none was nondiabetic. Most of the euthyroid (n=11) 92% and all of the hyperthyroid patients (n=13) 100% had HbA1C in the nondiabetic range of 6.5%). The correlation of HbA1C with TSH, Hb and MCH of these patients showed statistical significance (p 6.5%) or prediabetic (HbAIc between 5.7 to 6.5%)

Erythrocyte Morphology in Women of Reproductive Age (WORA) with Anemia

Anemia is a decrease in the number of erythrocytes in the blood circulation or the level of hemoglobin that is less than normal. The three major body mechanisms that cause anemia are excessive destruction of erythrocytes, blood loss, and decreased erythrocyte production. Based on the Basic Health Research (Riskesdas) in 2013, the prevalence of anemic women of reproductive age (WORA) aged 15-44 years in Indonesia was 35.3%. Anemia is classified based on the morphology of erythrocytes, including hypochromic microcytic, normocytic normochromic, and macrocytic. Erythrocyte morphology can be observed using peripheral blood smear examination. The objective of this study was to determine the morphology of erythrocytes in anemic women of reproductive age. This study belongs to descriptive research. The population of the study was 136 women of reproductive age, covering the students of D-IV in Medical Laboratory Technology at Setia Budi University. Forty-one respondents suffering from anemia were taken using a purposive sampling technique. The types of anemia were determined with examination using an Easy Touch hemoglobinometer with the Hb level of less than 12g/dL. Preparation of peripheral blood smear examination using EDTA venous blood and stained with Giemsa. Microscopic examination was performed with 1000x objective magnification. The peripheral blood smear reading showed the erythrocyte morphology that includes normocytic normochromic (38 samples or 93%), microcytic hypochromic (three samples or 7%), and poikilocytosis consisting of teardrop cells, target cells, ellipstocytes, and stomatocytes (five samples or 18%). Further study is required to investigate the correlation of erythrocyte index and peripheral blood smear in anemia