Abstract 78: An Incomplete Kawasaki Disease Child With Initial Presentation Of Murmur

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Lucy Y Eun ◽  
Yunjung Choi ◽  
Mindong Sung ◽  
Jo Won Jung ◽  
Jae Young Choi
Keyword(s):  
Kawasaki Disease ◽  
Saturation Index ◽  
Transferrin Saturation ◽  
Hemoglobin Concentration ◽  
Initial Presentation ◽  
Deficiency Anemia ◽  
Laboratory Studies ◽  
Incomplete Kawasaki Disease ◽  
Cardiac Murmur ◽  
Study Results

Abstract: Kawasaki disease(KD) is acute vasculitis in childhood. The authors report the 12-month-old girl with initial presentation of cardiac murmur who was diagnosed incomplete KD. Case: A 12-month-old girl with history of 3 days fever up to 38°C and upper respiratory symptoms including rhinorrhea visited a pediatric clinic. Cardiac murmur was noticed, then she was referred to Pediatric Cardiology clinic. She had loss of appetite and her growth curve showed severely underweight of 8.4kg(less than 3p) compared to height 78cm(50~75p). On hospital day 1, laboratory studies revealed a white blood cell (WBC) 9.4(seg73%, Lym23%)x 103/uL, hemoglobin concentration(Hb) of 5.5 g/dL with hematocrit(Hct) 21%, platelet count 426,000/uL. And laboratory results included ESR 2mm/hr, C-reactive protein 0.05mg/L, AST/ALT 31/19 IU/L, Ferritine 13 ng/mL, TIBC 510ug/dL, Transferrin Saturation Index 2.5% and MCV 50.4fL, MCH 13.4pg, MCHC 26.5g/dL. She had grade II-III/VI end-systolic & early diastolic murmur. The echocardiography showed left main coronary artery dilatation and pericaridial effusion. Based on diagnosis of incomplete Kawasaki disease and iron deficiency anemia, she treated with IVIG(IV gamma globulin), acetylsalicyclic acid, packed RBC transfusion and supplement of oral iron. On hospital day 2, repeat laboratory studies revelaed Hb 6.5 g/dL, and the murmur decreased rapidly. 6 days later Hb was 9.3 g/dL. Pro-BNP was 352 pg/ml on hospital day 1 and repeat studies revealed 978 pg/ml on hospital day 2, 84pg/ml on hospital day 8. The patient was discharged 8 days after admission(on day 11 of her illness) without fever. After 1 month of discharge, she had gained weight to 10.5kg and laboratory study results Hb 11.0 g/dL. And follow-up echorcardiography showed improvement of coronary arteries. The authors report one child presenting with heart murmur under incomplete Kawasaki disease.

scholarly journals Quando la carenza di ferro diventa rara…

QUADERNI ACP ◽  
2021 ◽  
Vol 28 (5) ◽  
pp. 254
Author(s):  
Marianna Casertano ◽  
Nicoletta Di Maio ◽  
Angela Maria Caprio ◽  
Maddalena Casale ◽  
Sofia MR Matarese ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Saturation Index ◽  
Transferrin Saturation ◽  
Microcytic Anemia ◽  
Deficiency Anemia ◽  
Childhood And Adolescence ◽  
Nutritional Disorder ◽  
Common Causes ◽  
The World ◽  
Additional Costs

Iron deficiency anemia is the most common nutritional disorder in the world, the most widespread form of anemia and the most frequent in children. In the presence of microcytic anemia, evidence of an iron deficiency (transferrin saturation index <10% and ferritin <12 mg/l) allows the diagnosis. An increase in requests and a reduced income are the most common causes in early childhood and adolescence. It is essential to ensure that the disorder is corrected at the end of therapy, in order to exclude rarer causes of iron deficiency. A correct diagnosisi and therapy are also essential to guarantee patients so to spare additional costs and stress for the whole family.

scholarly journals Association of Body Mass Index with Hemoglobin Concentration and Iron Parameters in Iranian Population

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Akram Ghadiri-Anari ◽  
Narjes Nazemian ◽  
Hassan-Ali Vahedian-Ardakani
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Serum Iron ◽  
Saturation Index ◽  
Transferrin Saturation ◽  
Elevated Serum ◽  
Hemoglobin Concentration ◽  
Low Grade ◽  
Anemia Of Chronic Disease ◽  
Iron Parameters

Background. Studies have reported that obesity has an adverse effect on iron metabolism. Obesity is characterized by chronic, low-grade, systemic inflammation and anemia of chronic disease with elevated serum ferritin and decreased level of serum iron, transferrin saturation, and hemoglobin. Therefore, we examined the association of body mass index with hemoglobin concentration and iron parameters in this study. Methods. This cross-sectional study was conducted in Yazd to assess the relation of body mass index with hemoglobin and iron parameters among 406 adult patients 18–65 years old. Diabetes and conditions that could influence body iron stores were excluded. Results. There is no difference in hemoglobin concentrations, MCV, serum iron, TIBC, transferrin saturation index, and ferritin between normal weight, overweight, and obese persons. Conclusion. Nutritional status of persons and intake of high iron foods by obese persons should be considered. Also, other inflammatory markers should be evaluated in the future studies.

scholarly journals Pregnancy and Anemia of Various Origin: Effectiveness of a Differentiated Approach

Doctor Ru ◽  
2020 ◽  
Vol 19 (8) ◽  
pp. 25-31
Author(s):  
B.M. Gasanova ◽  
◽  
M.L. Polina ◽  
◽  
◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Iron Deficiency Anemia ◽  
Hemoglobin Concentration ◽  
Deficiency Anemia ◽  
Cytokine Profiles ◽  
Tnf Α ◽  
Study Results ◽  
Ifn Γ ◽  
The Impact

Study Objective: To assess the impact of ferrokinetics and serum cytokine profiles on pregnancy outcomes in patients with anemia of various origin. Study Design: This was a prospective study. Materials and Methods: A complete blood count was done and levels of serum iron, C-reactive protein (CRP), total protein, and ferritin, as well as cytokine profiles (interleukin [IL]-1β, -4, -8, -10, tumor necrosis factor [TNF]-α, and interferon [IFN]-γ), were assessed in pregnant women with iron deficiency anemia (IDA) (n = 34) and infection-related anemia (n = 28). Study Results: In patients with IDA, hemoglobin concentration, red blood cell (RBC) count, mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC) were significantly lower (p<0.05) than in patients with infection-related anemia. Markers of infection-related anemia—increased levels of ferritin (in 82.2% of the women) and CRP—suggested the need for anti-inflammatory and antioxidant treatment. Women with infection-related anemia had higher levels of pro-inflammatory cytokines than women with IDA (p<0.05): IL-1β levels were 1.7 times higher; those of IL-8 and IFN-γ were 1.4 and 1.8 times higher, respectively, and those of TNF-α and IL-10 were 2.3 and 2.0 times higher, respectively. The study revealed a relationship between infection-related anemia and various gestational complications (OR = 1.1–3.5) and placental insufficiency (100.0% vs. 63.8% in IDA). Conclusion: To reduce the frequency of unfavorable perinatal outcomes, differentiated management is required for pregnant women with IDA and infection-related anemia. An optimal approach for women with anemia of any origin includes improvement of the woman’s general health before conception and preventive measures against obstetric complications starting in the early stages of pregnancy. Keywords: iron deficiency anemia, infection-related anemia, ferritin.

scholarly journals Iron treatment of pregnant sows in a Danish herd without iron deficiency anemia did not improve sow and piglet hematology or stillbirth rate

2019 ◽  
Vol 61 (1) ◽  
Author(s):  
Sheeva Bhattarai ◽  
Tore Framstad ◽  
Jens Peter Nielsen
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Intramuscular Injection ◽  
Transferrin Saturation ◽  
Hemoglobin Concentration ◽  
Deficiency Anemia ◽  
Hemoglobin Synthesis ◽  
Enzyme Systems ◽  
Iron Treatment

Abstract Background Anemia characterized by low hemoglobin concentration (HbC) is common in indoor housed pregnant sows. Iron is essential for hemoglobin synthesis and a number of metabolic processes including DNA synthesis and regulation of enzyme systems. In sows, anemia has been linked to lower HbC in piglets and increased occurrence of stillbirths. Therefore, the main objective of this study was to evaluate the effect of iron injection on hematology of pregnant sows and their offspring. Other objectives were to evaluate the effect of this injection on the probability of stillbirths and to study the tolerability of injected iron. Results A sow herd with bi-weekly batch farrowing was selected for the study and 100 sows at mid-gestation were randomly assigned to either a treatment (FeT) or a control (FeC) group. At the time of recruitment to the study (baseline), 46% of the sows in the herd were anemic with a HbC less than 103 g/L. However, none of the anemic sows had iron deficiency anemia on erythrocyte characterization. HbC decreased numerically during gestation in both the FeT (− 2.48 g/L) and FeC (− 2.99 g/L) groups but the decrease was insignificant between the groups (P = 0.79). Likewise, the change from baseline to farrowing and from baseline to post-farrowing in other hematologic variables was similar for both groups. The percentage of transferrin saturation was not statistically different between groups (P = 0.14). There was a batch effect (week of breeding) in most of the hematologic variables. The probability of stillbirth in the two groups did not differ (P = 0.94). None of the hematologic variables in piglets was significantly different between the two groups. The sows tolerated the iron injection well. Conclusions Intramuscular injection of two doses of 2500 mg iron 2 weeks apart at mid-gestation did neither change hematologic variables in sows nor in the piglets at farrowing. Similarly, iron treatment did not reduce the probability of stillbirths among the offspring. The sows recruited in this study tolerated the iron injections well. Further characterization of erythrocytes did not support that sows had iron deficiency anemia at baseline. Therefore, further studies on animals with well-defined anemia and with focus on the iron regulating hormone hepcidin are recommended.

scholarly journals Economic Benefits of Switching From Intravenous to Subcutaneous Epoetin Alfa for the Management of Anemia in Hemodialysis Patients

2020 ◽  
Vol 7 ◽  
pp. 205435812092753 ◽  
Author(s):  
Bhanu Prasad ◽  
Maryam Jafari ◽  
Julie Toppings ◽  
Linda Gross ◽  
Joanne Kappel ◽  
...  
Keyword(s):  
Ferritin Level ◽  
Transferrin Saturation ◽  
Hemoglobin Concentration ◽  
Economic Benefits ◽  
Target Range ◽  
Rank Test ◽  
Epoetin Alfa ◽  
Dialysis Unit ◽  
Study Results ◽  
Iv Iron

Background: Erythropoiesis-stimulating agents including epoetin alfa have been a mainstay of anemia management in patients with chronic kidney disease. Although the standard practice has been to administer epoetin alfa to patients on hemodialysis (HD) intravenously (IV), subcutaneous (SQ) epoetin alfa is longer acting and achieve the same target hemoglobin level to be maintained at a reduced dose and cost. Objective: The primary objective of this study was to determine the economic benefits of change in route of epoetin alfa administration from IV to SQ in HD patients. The secondary objectives were (1) to determine the differences in epoetin alfa doses at the pre-switch (IV) and post-switch period (SQ) and (2) to determine serum hemoglobin concentration, transferrin saturation, ferritin level, IV iron dose and cost in relationship to route of epoetin alfa administration. Design: This retrospective observational study included patients who transitioned from IV to SQ epoetin alfa. Setting: Two HD sites in southern Saskatchewan (Regina General Hospital, and Wascana Dialysis Unit, Regina) and 2 sites in northern Saskatchewan (St. Paul’s [SPH] Hospital, and SPH Community Renal Health Center, Saskatoon). Patients: The study includes 215 patients who transitioned from IV to SQ and were alive at the end of 12-month follow-up period. Measurements: We calculated the dose and cost of different routes of epoetin alfa administration/patient month. Also, serum hemoglobin, markers of iron stores (transferrin saturation and ferritin), IV iron dose, and cost were determined in relation to route of epoetin alfa administration. Methods: Data were gathered from 6 months prior (IV) to 12 months after switching treatment to SQ. The paired t-test and Wilcoxon signed-rank test were used to compare variables between pre-switch (IV) and post-switch (SQ) period. Results: The median cost (interquartile range) of epoetin alfa/patient-month decreased from (CAD508.3 [CAD349-CAD900.8]) pre-switch (IV) to (CAD381.2 [CAD247-CAD681]) post-switch (SQ) ( P < .001), a decrease of 25%. The median epoetin alfa dose/patient-month reduced from (38 500 [25 714.3-64 166.5] international unit) pre-switch to (26 750.3 [17 362.6-48 066] IU) post-switch ( P < .001), a decrease of 30.51%. The mean hemoglobin concentration (± standard deviation) for patients in both periods remained stable (103.3 ± 9.2 vs 104.3 ± 13.3 g/L, P = .34) and within the target range. There were no significant differences in transferrin saturation, ferritin, and IV iron dose and cost between the 2 study periods. Limitations: We were unable to consistently obtain information across all the sites on hospitalizations, inflammatory markers, nutritional status, and gastrointestinal bleeding. In addition, as our study sample was subject to survival bias, we cannot generalize our study results to other populations. Conclusions: We have shown that administering epoetin alfa SQ in HD patients led to a 30.51% reduction in dose and 25% reduction in cost while achieving equivalent hemoglobin levels. Given the cost sparing advantages without compromising care while achieving comparable hemoglobin levels, HD units should consider converting to SQ mode of administration. Trial registration: The study was not registered on a publicly accessible registry as it was a retrospective chart review and exempted from review by the Research Ethics Board of the former Regina Qu’Appelle Health Region.

scholarly journals Estimates of iron sufficiency in the US population

Blood ◽  
1986 ◽  
Vol 68 (3) ◽  
pp. 726-731 ◽  
Author(s):  
JD Cook ◽  
BS Skikne ◽  
SR Lynch ◽  
ME Reusser
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Status ◽  
Adult Population ◽  
Hereditary Hemochromatosis ◽  
Transferrin Saturation ◽  
Hemoglobin Concentration ◽  
Deficiency Anemia ◽  
Body Iron ◽  
The Us

Traditionally the iron status of a population is assessed by estimating the prevalence of iron deficiency anemia. This approach is inadequate in countries where the diet is heavily fortified with iron because it conveys no information about the iron-replete segment of the population. In the present study iron status of a US adult population was evaluated using data collected in the second National Health and Nutrition Examination Survey (NHANES II). Body iron was estimated in each of 2,829 individuals from measurements of hemoglobin concentration, serum ferritin, transferrin saturation, and erythrocyte protoporphyrin. When individuals between 18 and 64 years of age were divided on the basis of sex and menstrual status, body iron reserves were normally distributed and averaged 309 mg in women 18 to 44 years, 608 mg in women 45 to 64 years, and 776 mg in men 18 to 64 years. The dispersion of storage iron in these groups was similar, with standard deviations of 346, 372, and 313 mg, respectively. The prevalence of iron deficiency anemia was surprisingly low, ranging from only 0.2% in adult men to 2.6% and 1.9% in pre- and postmenopausal women, respectively. Epidemiologic methods that examine iron status in the entire population assume importance in light of evidence that in certain segments of the US population, iron deficiency anemia is now less common than the homozygous state for hereditary hemochromatosis.

scholarly journals Estimates of iron sufficiency in the US population

Blood ◽  
1986 ◽  
Vol 68 (3) ◽  
pp. 726-731 ◽  
Author(s):  
JD Cook ◽  
BS Skikne ◽  
SR Lynch ◽  
ME Reusser
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Status ◽  
Adult Population ◽  
Hereditary Hemochromatosis ◽  
Transferrin Saturation ◽  
Hemoglobin Concentration ◽  
Deficiency Anemia ◽  
Body Iron ◽  
The Us

Abstract Traditionally the iron status of a population is assessed by estimating the prevalence of iron deficiency anemia. This approach is inadequate in countries where the diet is heavily fortified with iron because it conveys no information about the iron-replete segment of the population. In the present study iron status of a US adult population was evaluated using data collected in the second National Health and Nutrition Examination Survey (NHANES II). Body iron was estimated in each of 2,829 individuals from measurements of hemoglobin concentration, serum ferritin, transferrin saturation, and erythrocyte protoporphyrin. When individuals between 18 and 64 years of age were divided on the basis of sex and menstrual status, body iron reserves were normally distributed and averaged 309 mg in women 18 to 44 years, 608 mg in women 45 to 64 years, and 776 mg in men 18 to 64 years. The dispersion of storage iron in these groups was similar, with standard deviations of 346, 372, and 313 mg, respectively. The prevalence of iron deficiency anemia was surprisingly low, ranging from only 0.2% in adult men to 2.6% and 1.9% in pre- and postmenopausal women, respectively. Epidemiologic methods that examine iron status in the entire population assume importance in light of evidence that in certain segments of the US population, iron deficiency anemia is now less common than the homozygous state for hereditary hemochromatosis.

scholarly journals Laboratory tests of iron status: correlation or common sense?

1996 ◽  
Vol 42 (5) ◽  
pp. 718-724 ◽  
Author(s):  
J Hastka ◽  
J J Lasserre ◽  
A Schwarzbeck ◽  
A Reiter ◽  
R Hehlmann
Keyword(s):  
Iron Deficiency ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Hemoglobin Concentration ◽  
Deficiency Anemia ◽  
Zinc Protoporphyrin ◽  
Iron Supply ◽  
Iron Deficient ◽  
Red Cell Indices ◽  
Total Body

Abstract We demonstrate that simple correlation between the various tests of iron status is not sufficient for examining their value in diagnosing iron deficiency (ID). Three degrees of ID are recognized: Iron depletion (ID grade I) is defined by decreased total body iron and normal iron support to erythropoiesis, as diagnosed by decreased storage iron, decreased ferritin, normal sideroblast count, normal zinc protoporphyrin (ZPP), and transferrin saturation &gt;15%. When the iron supply to erythropoiesis becomes insufficient, as diagnosed by transferrin saturation &lt; or = 15%, increased ZPP, and decreased sideroblast count, iron-deficient erythropoiesis (ID grade II) occurs. When finally hemoglobin is below its normal range, iron-deficiency anemia (ID grade III) results. The various tests for ID cannot be compared without taking into account the severity of the deficiency. Depending on the grade of ID examined, the correlation of markers seen in our patients' data varied considerably. We conclude that a "best" marker of ID does not exist. However, the different tests efficiently complement each other by detecting different stages and individually show the clinical extent of ID. Ferritin reflects the iron stores. ZPP indicates whether the ID in a given patient is clinically relevant or not. Finally, the extent of a clinically relevant ID can be assessed by the measured ZPP, hemoglobin concentration, and red cell indices.

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