Iron deficiency

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Expression of the iron hormone hepcidin distinguished different types of anemia in African children

Childhood anemia is a major global health problem resulting from multiple causes. Iron supplementation addresses iron deficiency anemia but is undesirable for other types of anemia and may exacerbate infections. The peptide hormone hepcidin governs iron absorption; hepcidin transcription is mediated by iron, inflammation, and erythropoietic signals. However, the behavior of hepcidin in populations where anemia is prevalent is not well established. We show that hepcidin measurements in 1313 African children from The Gambia and Tanzania (samples taken in 2001 and 2008, respectively) could be used to identify iron deficiency anemia. A retrospective secondary analysis of published data from 25 Gambian children with either postmalarial or nonmalarial anemia demonstrated that hepcidin measurements identified individuals who incorporated >20% oral iron into their erythrocytes. Modeling showed that this sensitivity of hepcidin expression at the population level could potentially enable simple groupings of individuals with anemia into iron-responsive and non–iron-responsive subtypes and hence could guide iron supplementation for those who would most benefit

The prevalence of anaemia, hypochromia and microcytosis in preoperative cardiac surgical patients

This retrospective study aimed to determine the prevalence of preoperative anaemia, hypochromia and microcytosis in cardiac surgery patients. Data was analysed for 943 patients (over a two-year period) undergoing coronary artery bypass graft, valve or combined coronary artery bypass graft and valve surgery at a tertiary hospital in South Australia. Overall prevalence of preoperative anaemia was 25.2%, greater in males than females (27.6 vs 19.9%, P 65 years of age (P=0.003). Anaemic patients with low red cell indices had lower preoperative haemoglobin than anaemic patients without low red cell indices (median haemoglobin 112 vs 120 g/l, P=0.008). Compared to non-anaemic patients, anaemic patients had higher transfusion rates (79.8 vs 46.4%, P <0.0001), which were greater in those with reduced red cell indices compared to those with normal red cell indices (93.5 vs 76.6%, P=0.01). This study demonstrated a high prevalence of preoperative anaemia, microcytosis and hypochromia in cardiac surgical patients.O David, R Sinha, K Robinson, D Cardon

Treatment of Boerhaave’s syndrome

Boerhaave's syndrome is the spontaneous transmural rupture of the esophagus. A high degree of clinical suspicion is a prerequisite for its prompt diagnosis, and early therapeutic intervention reduces its associated morbidity and mortality. Factors that influence the outcome are location and extent of perforation and the timing of medical or surgical treatment. Boerhaave's syndrome is the most lethal perforation of the gastrointestinal tract. Delay in intervention relates directly to increased mortality. Despite advances in surgical techniques and endoscopic therapies, this disorder still has high morbidity and mortality rates. The outcome of patients with this disorder is dependent upon the prompt and accurate diagnosis. Initial stabilization of the patient with intravenous fluids and antibiotics is of key importance, with subsequent decisive therapy initiated using either a conservative medical or endoscopic or surgical approach. Boerhaave's syndrome often occurs in otherwise-relatively healthy patients. This postemetic perforation of the esophagus can result in a devastating injury that usually is exacerbated by delayed diagnosis. This article will focus on its clinical presentations and review its potentially applicable therapies