Prediction of Iron Deficiency Anemia in Third Trimester of Pregnancy Based on Data in the First Trimester: A Prospective Cohort Study in a High-Income Country

International audienceBackground: Systematic iron supplementation may be harmful in pregnant women with non-depleted iron. Our objectives were to estimate the prevalence of anemia at the third trimester of pregnancy (T3) and to identify the parameters at the first trimester (T1), which best predict anemia at T3. Methods: This prospective cohort study in France included pregnant women at T1 without non-iron deficiency anemia. Clinical and social characteristics, health-related quality of life, blood count, and a frozen blood sample were collected at T1 and/or T3. Secondly, a matched nested case-control study was built for women with anemia at T3 but not at T1. Multivariate analyses and ROC curves were used to identify the best predictive parameter(s) of anemia at T3. Results: The prevalence of anemia at T3 in the cohort (629 women) was 21.9% (95% CI 18.7-25.2%). In the matched nested case-control study (256 women), hemoglobin (Hb), serum ferritin (SF) and the SF/soluble transferrin receptor ratio at T1 were predictive of anemia at T3 (p < 0.001); however, clinical and social characteristics, as serum hepcidin were not. In multivariate analyses, Hb at T1 was the best predictive biomarker of anemia at T3 with a cutoff value of 120 g/L (specificity 87.5%). Conclusions: The prevalence of anemia at the end of pregnancy remained high in a High-Income Country. Clinical, social, and biochemical parameters did not seem useful to predict anemia at T3 and could not guide iron supplementation. We suggest systematically performing a simple blood count in the first trimester of pregnancy and offering oral iron supplementation for women with Hb < 120 g/L

Use of transgenic mice model for understanding the placentation: towards clinical applications in human obstetrical pathologies?

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Évaluation des performances de l’automate STA R Max® (Stago) pour les paramètres d’hémostase de routineEvaluation of the coagulometer STA R Max (R) (Stago) for routine coagulation parameters

International audienceLe STA R Max® (Stago) est un coagulomètre à détection viscosimétrique. Il est doté d’un logiciel innovant (le système STA Coag Expert®) comportant un menu « accréditation » et permet une traçabilité totale de 5 ans. Le but de cette étude était d’évaluer ses performances avec les 3 méthodes de détection embarquées en vue d’une vérification de méthode selon la norme ISO 15189. Ce travail s’est déroulé au sein du service d’hématologie biologique du CHU de Clermont-Ferrand qui possède 4 STA R Max® répartis sur 2 sites et dédiés à l’activité de routine d’hémostase. Les paramètres étudiés étaient les suivants : le taux de prothrombine (TP), les temps de céphaline avec activateurs (TCA et TCK), le fibrinogène, l’activité anti-Xa et les D-dimères ; chacun testé dans les zones normales et pathologiques. Pour les analyses TP, TCA, TCK et fibrinogène, les coefficients de variation (CV) des répétabilités étaient inférieurs à 4,0 %. Les CV de répétabilité de l’activité anti-Xa et des D-dimères étaient respectivement au maximum de 4,0 % et 7,9 %. Les CV de la fidélité intermédiaire étaient inférieurs à 5,0 % pour TP, TCA, TCK et fibrinogène, 14,9 % pour l’activité anti-Xa et 8,6 % pour les D-dimères. Le biais (évaluant l’inexactitude) était inférieur à 8,7 % pour le TP, TCA et TCK, à 5,0 % pour le fibrinogène et inférieur à 15,5 % pour l’activité anti-Xa. L’étude de la concordance entre les 4 automates (corrélation intra-classe) retrouvait des coefficients de corrélation intra-classe de 0,99 pour tous les paramètres sauf le TCA (0,98). La concordance entre les automates était excellente. L’ensemble des résultats obtenus sont satisfaisants au regard des recommandations du Groupe français d’études sur l’hémostase et la thrombose (GFHT) et le fournisseur. Le STA R Max® est un analyseur performant pour gérer l’activité d’hémostase de routine d’un laboratoire et présente l’avantage de faciliter la démarche d’accréditation

Epidemiology and outcome of thrombocytopenic patients in the intensive care unit: results of a prospective multicenter study.

International audiencePURPOSE: To assess the epidemiology of intensive care unit (ICU) patients with thrombocytopenia (TP). METHODS: All consecutive ICU-admitted patients with TP either on admission or acquired during ICU stay were included. TP was defined as either absolute (platelet count 30 %). Extensive diagnostic workup of TP including bone marrow aspiration was performed. RESULTS: Absolute TP was diagnosed in 208 patients and relative TP in 93. In six patients (2 %), no cause of TP was identified. The median number of TP etiologies per patient was two, with sepsis being the leading cause. Bone marrow aspirates were analyzed in 238 patients. They showed a normal megakaryocyte number in 221 (93 %) and provided novel information for diagnosis in 52 (22 %). Results were susceptible to having an impact on patient management in 22 cases (11 %). The frequency of bone marrow aspiration with results susceptible to having an impact on management did not differ between patients with and without disseminated intravascular coagulation (P = 0.22) and with and without sepsis/septic shock (P = 0.7) but was significantly lower in patients with relative TP than in those with absolute TP (P < 0.01). A serious bleeding event was observed in 30 patients (14.9 %) and a nadir platelet count below 50 × 10(9)/L was an independent risk factor (P < 0.05). CONCLUSIONS: In thrombocytopenic patients, sepsis is the leading cause of TP. Bone marrow aspirates may yield significant information on TP mechanisms and contribute to the subsequent management of patients, especially those with absolute TP