Mild anemia and 11- to 15-year mortality risk in young-old and old-old: Results from two population-based cohort studies

Background Mild anemia is a frequent although often overlooked finding in old age. Nevertheless, in recent years anemia has been linked to several adverse outcomes in the elderly population. Objective of the study was to investigate the association of mild anemia (hemoglobin concentrations: 10.0–11.9/12.9 g/dL in women/men) with all-cause mortality over 11–15 years and the effect of change in anemia status on mortality in young-old (65–84 years) and old-old (80+ years). Methods The Health and Anemia and Monzino 80-plus are two door-to-door, prospective population-based studies that included residents aged 65-plus years in Biella municipality and 80-plus years in Varese province, Italy. No exclusion criteria were used. Results Among 4,494 young-old and 1,842 old-old, mortality risk over 15/11 years was significantly higher in individuals with mild anemia compared with those without (young-old: fully-adjusted HR: 1.35, 95%CI, 1.15–1.58; old-old: fully-adjusted HR: 1.28, 95%CI, 1.14–1.44). Results were similar in the disease-free subpopulation (age, sex, education, smoking history, and alcohol consumption adjusted HR: 1.54, 95%CI, 1.02–2.34). Both age groups showed a dose-response relationship between anemia severity and mortality (P for trend <0.0001). Mortality risk was significantly associated with chronic disease and chronic kidney disease mild anemia in both age groups, and with vitamin B12/folate deficiency and unexplained mild anemia in young-old. In participants with two hemoglobin determinations, seven-year mortality risk was significantly higher in incident and persistent anemic cases compared to constant non-anemic individuals in both age groups. In participants without anemia at baseline also hemoglobin decline was significantly associated with an increased mortality risk over seven years in both young-old and old-old. Limited to the Monzino 80-plus study, the association remained significant also when the risk was further adjusted also for time-varying covariates and time-varying anemia status over time. Conclusions Findings from these two large prospective population-based studies consistently suggest an independent, long-term impact of mild anemia on survival at older ages.

Enormity of iron deficiency anaemia and haematological indices in Primary and secondary school going children in central rural Gujarat, India

Anemia is one of the associated and underlying health conditions observed in large number of school going children of rural India. National Family Health Survey (NHFS) data published by Government of Indiaindicates increased prevalence ofanaemia in children of rural India. In the present study, children of government school of the Waghodia tehsil, Vadodara district Gujarat were surveyed. A cross sectional study was conducted to survey 500 children of either genderaccording to WHO gradation as normal range (12.6 ± 0.54 gm/dl); mild anemia (11.01 ± 0.58gm/dl) and moderate anemia(9.11 ± 0.3gm/dl).Observations indicated that, 20.6%, 74.8% and 4.6%children were in normal or above normal range, mild anemia and moderate anemia respectively. Overall79.4% of children have anemia. It reveals the escalating magnitude of prevalence of IDA in rural Gujarat. Prevalence is more in 9-11 age group (56%). Gender wise distribution shows mild and moderate anemia in 305 (80.9%) and 14 (3.7%) respectively amongst 377 male children; whereas mild anemia and moderate anemia in 305 (80.9%) and 14 (3.7%) respectively amongst 123 female children. In nutshell, prevalence of anemia is prominent in children of age group in different rural parts of Gujarat.

A study on prevalence of anemia among antenatal females registered at rural health training centre, Budhi in district Kathua

Background: Anemia has been recognized as the most common form of nutritional deficiency worldwide, particularly in developing countries like India. Anemia is a public health problem in both developed and developing countries. It affects 1.62 billion people globally, which corresponds to 24.8% of the world population. Though anemia is easily treatable and preventable disease, it continues to be significantly associated with pregnancy. The aims of the study were to determine the magnitude of anemia in pregnant women according to severity and to find out association of anemia with different variables.Methods: The present study was a retrospective type of study which was conducted over a period of 2 years. A total of 109 antenatal females were registered over the period of 2 years.Results: The most common age group seen was 26-30 years (45%), majority of females were Hindu (95.4%) and belonged to lower socio-economic status (52.3%). The obstetrics history of the antenatal females’ shows, majority of them registered themselves in their 1st trimester (73.4%) and around 22.1% of the females had birth interval between 2-3 years, followed by 1-2 years. Majority of them had moderate anemia (82%), followed by mild anemia (10%). Only 1% of females had severe anemia while rest had no anemia (7%).Conclusions: This study revealed a high prevalence of anemia in antenatal females, irrespective of religion, socio-economic status, etc. anemia is found to be endemic in this region, due to various unfavorable socio-demographic factors. Strengthening of the existing adolescent and maternal health interventions focusing towards anemia screening and prevention among reproductive age group.

Asuhan Kebidanan pada Ibu Hamil Trimester III dengan Anemia

Anemia is a condition where the level of hemoglobin in the blood is less than the normal limit (<12 g%) caused by a lack of iron in the body due to malnutrition. While anemia in pregnancy is a condition where the hemoglobin level in pregnant women is <11gr% or <10.5gr% in third trimester pregnant women which generally occurs due to the hemodilution process. The purpose of this case to find out the cause of anemia in late pregnancy and the treatment that can be done to prevent complications that occur with care to routinely consume blood-added tablets (Fe) and recommend foods high in iron. This care design used a comprehensive care method for pregnant women in the third trimester who experience mild anemia (haemoglobin <10,5gr%) in Kalimade Village, Kesesi District, Pekalongan Regency. The results of this care showed an increase in hemoglobin levels in the mother. The conclusion of this case study shows that regularly consuming Fe tablets can increase hemoglobin levels in the blood so that it can prevent and treat anemia. For this reason, pregnant women are expected to routinely consume Fe tablets during pregnancy and midwives are expected to provide education about the benefits of Fe tablets to pregnant women to prevent anemia.Keywords: Haemoglobin; Anemia; Pregnancy AbstrakAnemia merupakan suatu kondisi dimana kadar haemoglobin dalam darah kurang dari batas normal (<12 gr%) yang disebabkan karena kurangnya zat besi didalam tubuh akibat kurang gizi. Sedangkan anemia pada kehamilan adalah kondisi dimana kadar haemoglobin pada ibu hamil <11gr% atau <10,5gr% pada ibu hamil trimester III yang umumnya terjadi karena adanya proses hemodilusi. Tujuan dari kasus ini yaitu untuk mengetahui penyebab terjadinya anemia pada kehamilan lanjut serta penanganan yang dapat dilakukan guna mencegah terjadinya komplikasi yang mungki terjadi dengan asuhan untuk rutin mengkonsumsi tablet tambah darah (Fe) serta anjuran mengkonsumsi makanan tinggi zat besi. Rancangan Asuhan ini menggunakan metode asuhan komprehensif pada ibu hamil trimester III yang mengalami anemia ringan (Haemoglobin <10,5gr%) di Desa Kalimade Kecamatan Kesesi Kabupaten Pekalongan. Hasil asuhan ini menunjukan adanya peningkatan kadar haemoglobin pada ibu. Simpulan studi kasus ini menunjukan bahwa dengan rutin mengkonsumsi tablet Fe dapat meningkatkan kadar Haemoglobin dalam darah sehingga dapat mencegah serta mengobati anemia. Untuk itu ibu hamil diharapkan agar rutin mengkonsumsi tablet Fe selama kehamilan. Bidan diharapkan agar bisa memberikan edukasi tentang manfaat tablet Fe pada ibu hamil guna mencegah terjadinya anemia.Kata kunci: Haemoglobin; Anemia; Kehamilan

Studi Kasus Kehamilan Dengan Risiko Tinggi

Maternal mortality rate (MMR) and infant mortality rate (IMR) are determinants and benchmarks for the success of health service delivery. In 2019 Indonesia's Maternal Mortality Rate (MMR) is still high, at 305 per 100,000 live births. The purpose of this case study is to provide midwifery care during pregnancy to high-risk mothers aged over 35 years and mild anemia to minimize complications that will occur. The method of this case study is to provide midwifery care to pregnant women with high risk in the form of exposure to the subject of one client who experiences a high risk of pregnancy who will be given care during pregnancy. The results of this case study are given care to reduce the complaints felt by the client and carry out early detection to reduce the occurrence of complications. The conclusion of this case study is midwifery care for Ny. N during pregnancy in Pekalongan has been carried out on high-risk patients aged more than 35 years and mild anemia according to the needs and authority of the midwife so that it does not cause any complications. For this reason, midwives need to provide care as a form of early detection to reduce the incidence of complicationsKey Word: Maternity care, pregnant, high risk AbstrakAngka kematian ibu (AKI) dan angka kematian bayi (AKB) menjadi penentu dan tolak ukur keberhasilan penyelenggaraan pelayanan kesehatan. Pada tahun 2019 Angka Kematian Ibu (AKI) Indonesia masih tetap tinggi, yaitu 305 per 100.000 kelahiran hidup. Tujuan dari studi kasus ini adalah memberikan asuhan kebidanan selama masa kehamilan pada ibu dengan risiko tinggi usia diatas 35 tahun dan anemia ringan untuk meminimalkan komplikasi yang akan terjadi. Metode studi kasus ini adalah dengan pemberian asuhan kebidanan pada ibu hamil dengan risiko tinggi berupa pemaparan dengan subyek satu klien yang mengalami risiko tinggi dalam kehamilanya yang akan diberikan asuhan selama masa kehamilan. Hasil studi kasus ini diberikan asuhan untuk mengurangi keluhan yang dirasakan klien serta melakukan deteksi dini untuk mengurangi terjadinya komplikasi. Simpulan studi kasus ini adalah asuhan kebidanan pada Ny. N selama masa kehamilan Pekalongan sudah dilakukan pada pasien yang mengalami risiko tinggi usia lebih dari 35 tahun dan anemia ringan sesuai kebutuhan dan kewenangan bidan sehingga tidak menimbulkan komplikasi apapun. Untuk itu bidan perlu melakukan asuhan sebagai bentuk deteksi dini untuk mengurangi timbulnya komplikasiKata kunci: asuhan kebidanan, ibu hamil, risiko tinggi

Diagnosis and clinical management of enzymopathies

At least 16 genetically determined conditions qualify as red blood cell enzymopathies. They range in frequency from ultrarare to rare, with the exception of glucose-6-phosphate dehydrogenase deficiency, which is very common. Nearly all these enzymopathies manifest as chronic hemolytic anemias, with an onset often in the neonatal period. The diagnosis can be quite easy, such as when a child presents with dark urine after eating fava beans, or it can be quite difficult, such as when an adult presents with mild anemia and gallstones. In general, 4 steps are recommended: (1) recognizing chronic hemolytic anemia; (2) excluding acquired causes; (3) excluding hemoglobinopathies and membranopathies; (4) pinpointing which red blood cell enzyme is deficient. Step 4 requires 1 or many enzyme assays; alternatively, DNA testing against an appropriate gene panel can combine steps 3 and 4. Most patients with a red blood cell enzymopathy can be managed by good supportive care, including blood transfusion, iron chelation when necessary, and splenectomy in selected cases; however, some patients have serious extraerythrocytic manifestations that are difficult to manage. In the absence of these, red blood cell enzymopathies are in principle amenable to hematopoietic stem cell transplantation and gene therapy/gene editing.

Mild Anemia May Affect Thyroid Function in Pregnant Chinese Women During the First Trimester

BackgroundPregnant women are often susceptible to anemia, which can damage the thyroid gland. However, compared with moderate and severe anemia, less attention has been paid to mild anemia. The purpose of this study was to evaluate the effect of mild anemia on the thyroid function in pregnant women during the first trimester.MethodsA total of 1,761 women in the first trimester of their pregnancy were enrolled from Shenyang, China, and divided into mild anemia and normal control groups based on their hemoglobin levels. Thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) levels were compared between the two groups.ResultsThe TSH levels of pregnant women with mild anemia were higher than those of pregnant women without mild anemia (p &lt; 0.05). Normal control women were selected to set new reference intervals for TSH, FT3, and FT4 levels during the first trimester, which were 0.11–4.13 mIU/l, 3.45–5.47 pmol/l, and 7.96–16.54 pmol/l, respectively. The upper limit of TSH 4.13 mU/l is close to the upper limit 4.0 mU/l recommended in the 2017 American Thyroid Association (ATA) guidelines, indicating that exclusion of mild anemia may reduce the difference in reference values from different regions. Mild anemia was related to 4.40 times odds of abnormally TSH levels (95% CI: 2.84, 6.76) and 5.87 increased odds of abnormal FT3 (95% CI: 3.89, 8.85). The proportion of hypothyroidism and subclinical hypothyroidism in patients with mild anemia was higher than that in those without anemia (0.6% vs. 0, p = 0.009; 12.1% vs. 1.9%, p &lt; 0.001). Mild anemia was related to 7.61 times increased odds of subclinical hypothyroidism (95% CI: 4.53, 12.90).ConclusionsMild anemia may affect thyroid function during the first trimester, which highlights the importance of excluding mild anemia confounding when establishing a locally derived specific reference interval for early pregnancy.

Safety, clinical and laboratory characteristics of donors with thalassemia minor in living donor kidney transplant: a case series

Background Due to the increasing demand for kidney transplants, sometimes donors with underlying medical conditions can be considered for living kidney donor transplant. Thalassemia is amongst the most common inherited disorders of hemoglobin globally, which is not restricted as an exclusion criterion. However, there is currently no study examine the safety and characteristics of kidney donors with thalassemia minor. Methods All eligible live kidney donors between 2016 and 2019 with thalassemia minor at a tertiary hospital were recruited. Baseline characteristics, clinical and laboratory outcomes were investigated. Results Fifteen donors (11 women, 55.5 ± 15.0 year-old) were included with a follow-up duration of 2 (1-4) years since operation. The most prevalent gene mutation among participants was DEL-SEA. No clinical manifestations of anemia were seen but 10 participants had mild anemia diagnosed from blood tests. Cardiovascular, liver and renal function were normal before nephrectomy. Until now, all donors are alive and maintain overall good health. Anemia condition is not affected, and the post-donation eGFR = 71.04 ± 11.54 mL/min/1.73m2 is comparable to outcomes of healthy donors reported in previous studies. Two donors are at risk of proteinuria at 1-year post-transplant with A/C ratio > 30 mg/g. Conclusions Thalassemia minor individuals who are non-transfusion-dependent, without anemia clinical manifestations and have no contraindications to kidney donation are safe to be donors in short-term. An eGFR of at least 80 mL/min/1.73m2 should be considered to avoid low post-donation eGFR, and awareness should be raised on thalassemia donors with even mild albuminuria. Nephrectomy does not worsen thalassemia.

Case Report on Mild Anemia and Gastritis due to Zidovudine, Lamivudine and Nevirapine (ZLN) Regimen

AIDS is a deadly syndrome in which Highly Active Anti-retroviral therapy is used to reduce the viral load. However these anti-retroviral drugs are supposed to cause several adverse drug reaction. There are several studies that report anemia with Zidovudine and gastrointestinal symptoms with Lamivudine. In this report, We present a case of a 38 year old female patient suffering from HIV infection who is suspected to drug induced anemia and gastritis due to Zidovudine, Lamivudine and Nevirapine combination (ZLN) regimen. The relationship between the administered drug regimen and the suspected ADR’s was found using causality assessment. Severity, predictability and probability was also found for the suspected ADR’s. We need to monitor the HIV patients who are under ZLN regimen for their blood haemoglobin and gastrointestinal symptoms.