Iron-Deficiency Anemia Related to Ancylostoma duodenale Infection in 67 Years Old Female Patient

Background. Ancylostomiasis is an infection caused by hookworms. It is estimated that hookworms infect 1.2 billion people worldwide and cause higher morbidity than other types, mainly due to iron deficiency anemia. Hookworm infection increases with age. The main clinical manifestations are abdominal pain, features of iron deficiency anemia and hypoproteinemia. Diagnosis is based on the finding of characteristic eggs in the stool. Case presentation. A 67-year-old female patient had been administered into the Internal Medicine Ward of Dr. M. Djamil Padang Hospital with the main complaint of weakness, fatigue, and lethargy which had increased since 3 days before being admitted to the hospital. The patient also had complaints of pale skin, fever, heartburn, decreased appetite and weight loss. The patient was admitted to the hospital with awareness of compost mentis, cooperative, and his general condition appeared to be moderately ill, blood pressure 130/90 mmHg, pulse rate 104 x/minute, regular pulse, adequate filling, respiratory rate 22 x/minute, temperature 37.8 C. On physical examination, the conjunctiva of the pantient’s eyes were anemic. Laboratory examination revealed Hemoglobin 4 g/dl, Hematocrit 16%, MCV/MCH/MCHC 62fl/15pg/25g/dL, Reticulocytes 0.5%, SI/TIBC 22/315 mg/dL, Ferritin 8.5 ng/mL, and peripheral blood smear showing severe hypochromic microcytic anemia and relative eosinofilia. Ancylostoma duodenale worm eggs were found on routine stool examination. Final diagnosis was Severe microcytic hypochromic anemia caused by an iron deficiency and Ancylostomiasis. Severe microcytic hypochromic anemia caused by iron deficiency and ancylostomiasis was established based on the patient’s history, physical examination and laboratory investigations. Conclusions. Hookworms infect many people worldwide and cause high morbidity, mainly due to iron deficiency anemia. The highest prevalence is found in the tropics and subtropics, including Indonesia. The main clinical manifestations are abdominal pain, features of iron deficiency anemia and hypoproteinemia. Diagnosis is based on the finding of characteristic eggs in the stool. Albendazole 400 mg single dose resulted in 80% cure and a dose of 200 mg/day for 3 days gave 100% cure. Treatment of anemia is by administering ferrous sulfate or ferrous gluconate orally 200 mg three times a day and continued for up to 3 months after normal hemoglobin levels are achieved to maintain iron stores.

Comparison of hematological parameters between single and twin pregnancies in Dorper ewes during gestation, lambing, and postpartum

ABSTRACT: The hematopoietic system changes during the pregnancy to carry fetal development and maternal needs. This study compared the hematological parameters between ewes with single and twin pregnancies during gestation, delivery, and postpartum. The experiment was conducted on 60 healthy pregnant Dorper ewes that were divided into two experimental groups: Group 1 (G1), with single pregnancies (n=30), and Group 2 (G2), with twin pregnancies (n=30). Blood samples were collected from all ewes at different times: immediately before fixed-time artificial insemination (AI); on day 30, 90, 120, 130, and 140 of pregnancy; immediately after delivery; and at 24h and 48h postpartum. Statistical analysis compared the two groups at different times (P<0.05). Mild, normocytic, and hypochromic anemia was detected in all ewes from AI time and throughout pregnancy from both groups, but did not prove to be of clinical relevance. In the peripartum stage (from the 140th day of pregnancy to 48h postpartum), the ewes with twin pregnancies (G2) exhibited higher erythrogram values and neutrophil:lymphocyte ratio than did ewes with single pregnancies (G1). This indicated a greater hematopoietic adaptation in the body during the development of two fetuses. Except for the eosinophil numbers, all leukogram parameters were influenced by pregnancy in a similar way in both groups, and was characterized mainly by leukocytosis with neutrophilia during peripartum due to the high presence of endogenous cortisol at delivery. Thus, these findings showed that pregnancy was a stressful physiological event that increased the leukocyte count with a slight alteration in the erythrogram of Dorper ewes.

Anemia and The Level of IL-6 in Children Infected with Entamoeba histolytica and Giardia lamblia

The relation between anemia and inflammatory immune response has lately had much attention. This research was conducted from October 2018 until April 2019, including (110) children below 12 years from both gender in some Hospitals, Primary Health care centers, Public Primary Schools and Kindergarten in Baghdad, Iraq. The objective of this study is to determine the possible correlation between iron deficiency anemia and inflammatory immune response among children infected with Entamoeba histolytica or Giardia lamblia. Blood samples were taken from all groups to measure hemoglobin level, serum iron, total iron binding capacity (TIBC), mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC), while the inflammatory related immune response was evaluated by measuring IL-6 and ferritin. Student T-Test was used to compare between means. The results showed that both hemoglobin and iron concentrations were significantly (P) ˂ 0.01 lower in infected children compared with control, as well as both IL-6 and ferritin levels were significant where (P) ˂0.05 amplified among infected children compared to control. Microcytic hypochromic anemia was observed in the majority of infected children, while normocytic normochromic RBCs was recorded in the majority of control children.

The effect of the red blood cell system disorders on the further development and productivity of Holstein calves that had had bronchopneumonia

The aim of this research was to study the effect of red blood cell system disorders on the further development and productivity of calves that had had bronchopneumonia. The study included 170 Holstein heifers at the age of 180-195 days: healthy heifers (n = 92) and heifers with moderate bronchopneumonia (n = 78). All animals had been under constant clinical supervision for 27 months. Blood sampling was performed in 10 animals from each group at the beginning of the experiment and on day 22, and also when they reached a body weight of 380 kg (the first artificial insemination), 30 days before the planned calving date, and on days 7, 90, 180 of lactation. The blood samples obtained were examined by a hematological analyzer, and the content of fetal hemoglobin was determined by Singer’s method. It was shown that after completion of the course of treatment the clinical symptoms of bronchopneumonia disappeared in calves, but microcytic hypochromic anemia appeared. Further, in these animals an increase was registered in the age of fruitful fertilization by 10.8% and of the insemination index by - 36.7%. After calving and during lactation, the severity of hypochromia decreased, but there was a tendency for macrocytosis, which, combined with increased anisocytosis, indicated hypoplastic anemia. This form of anemia occurred against the background of pathological residual changes after pneumonia due to the depletion of the compensatory potential of the bone marrow and its functional overload during lactation. The operational anemia revealed in lactating cows caused a decrease in milk productivity by 23.2-26.7% (P<0.01).

Associations between Serum Aflatoxin-B1 and Anemia in Pregnant Women: Evidence from Guangxi Zhuang Birth Cohort in China

Aflatoxin B1 (AFB1) is a common toxic mycotoxin and is detectable in pregnant women. Animal studies have revealed that AFB1 caused the lysis of erythrocytes and a decrease in hemoglobin. We conducted a prospective cohort study in Guangxi, China, in order to evaluate the association between AFB1 exposure and anemia in pregnant women during the entire pregnancy. A total of 616 pregnant women from the Guangxi Zhuang Birth Cohort were included in the study. Serum AFB1-albumin (AFB1-ALB) adduct levels were measured. The effect of AFB1-ALB adducts on hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) were analyzed by using multivariable linear regression. The risks of anemia from AFB1-ALB adduct exposure were assessed by multivariable logistic regression. We found that the AFB1-ALB adduct was significantly associated with a decrease in Hb (β = −4.99, 95% CI: −8.42, −1.30), MCV (β = −4.58, 95% CI: −7.23, −1.94), MCH (β = −1.86, 95% CI: −2.87, −0.85), and MCHC (β = −5.23, 95% CI: −8.28, −2.17) in the first trimester with the third tertile of AFB1-ALB adducts when compared with the first tertile. Furthermore, the third tertile of the AFB1-ALB adduct significantly increased the risk of anemia by 2.90 times than compared to the first tertile in the first trimester (OR = 3.90, 95% CI: 1.67, 9.14). A significant positive does–response relationship existed between AFB1-ALB adduct levels and anemia risk (Ptrend = 0.001). When dividing anemia types, we only found that the third tertile of AFB1-ALB adduct increased the risk of microcytic hypochromic anemia (MHA) in the first trimester (OR = 14.37, 95% CI: 3.08, 67.02) and second trimester (OR = 4.75, 95% CI: 1.96, 11.51). These findings demonstrate the correlation between maternal AFB1 exposure during early pregnancy and risk of anemia, especially MHA, and during different trimesters in Southern China. More efforts should be made to diminish AFB1 exposure for pregnant women.

Prevalence of nutritional anemia in children of high socioeconomic status in a tertiary care center

Background: Anemia is a highly prevalent condition developed in children belonging to all socioeconomic status and is mainly caused due to iron deficiency in nutrition. Aim: To identify the Prevalence of nutritional anemia in children of high socioeconomic status. Methods: Children between 6 months and 14 years of age belonging to high socioeconomic status, admitted in pediatric ward of Kauvery Hospital, a tertiary center at Trichy were included in the study. Children with hemolytic anemia, chronic illnesses, and those who received blood transfusion were excluded from the study. The World Health Organization classification was used for grading the severity of anemia as mild, moderate, and severe based on hemoglobin levels for the age. Modified Kuppuswamy scale 2016 was used to assess the socioeconomic status of the children. Children belonging to upper and upper middle socioeconomic status were included in the study. Results: The overall prevalence of anemia among the study population was 44.5%. Out of 400 subjects, 178 participants were anemic. Of the 178 anemic children, 78.1% were in the age group of 6 months–5 years, 20.2% in 5–11 years, and 1.7% in 12–14 years. Among children between 6 and 23 months, 75 were anemic. Almost all patients showed microcytic hypochromic anemia. There were a significantly higher number of overweight and obese children among those anemic in all age groups. Conclusion: This study concludes that every other child is anemic even in families of high socioeconomic status, especially <2 years of age. There is an urgent need to screen and treat all children regardless of their socioeconomic status or body mass index.

Prevalence of Anemia among Children Diagnosed with Pneumonia Attending Birat Medical College Teaching Hospital, Morang, Nepal

Introduction: Childhood pneumonia is the leading cause of serious illness and death worldwide. In developing countries, pneumonia is the biggest single cause of childhood death under the age of 5 years. Globally, anemia is a major nutritional problem of immense public health significance. Iron deficiency anemia in children occurs most frequently between the age of 6 months and 3years, the same period of age when repeated infections occur. Objective: The main objective of this study is to determine the prevalence of anemia among children diagnosed with pneumonia. Methodology: This is a hospital based cross sectional study carried out in the Department of Paediatrics, Birat Medical College Teaching Hospital, from 15th February 2020 to 15th August 2020. This study was performed on 150 pneumonic children between 6 to 60 months of age. History regarding fever, cough and fast breathing was taken. All the data were recorded in the preformed proforma. Data was analyzed using SPSS version 16. Results: This study was performed on 150 pneumonic children, in which male babies (n=93; 62%) outnumbered the female babies (n=57; 38%). The majority of children were in the age group of 6 to 24 month (n=85; 56.7%). The mean hemoglobin level was 9. 49±1.39 gm/dl. The hemoglobin level less than 11 gm/dl was seen in 102 (68%) cases. Microcytic hypochromic anemia was present in 73 (71.6%) children. Conclusion: The prevalence of anemia among the pneumonic children of 6-60 months is 68% that is higher than the national data (52.6%) of prevalence of anemia in the same age group. While treating childhood pneumonia, checking hemoglobin on regular basis will be very useful to diagnose and manage concurrent anemia

Cardiac and non-cardiac characteristics of Jervell-Lange-Nielsen syndrome

We aimed to analyze the management of children with Jervell-Lange-Nielsen syndrome based on their clinical and genetic characteristics and to assess the effectiveness of their therapy.Methods. We analyzed medical data from 12 Jervell and Lange-Nielsen syndrome patients. Mean follow-up was 8.3±5.1 years. Comprehensive cardiological examination include the standard 12-lead electrocardiography (ECG), echocardiography, stress-test, 24-hour Holter recordings, blood tests, thyroid ultrasound, and assessment of thyroid hormone levels, and if necessary, consultation with a neurologist.Results. At the first visit, the mean age was 3.0±2 years old, girls prevailed (67%). All patients are alive now. The mean QTc was 578.9±57.3 ms. Cardiac events had 10 patients (83%), mean age at the first event was 1.9±1.6 years. In 67% of children, syncope was initially regarded as epileptic. All patients received beta-blockers, which were prescribed at mean age 3.0±2.3 years (from 1 month to 7 years). In 8 patients cardiac events recurred despite regular and adequate beta-blocker therapy, all of them were implanted with implanted cardioverter-defibrillator. It was found that patients with the first syncope under the age of 1.5 and delayed initiation of therapy (at the mean age 4.3±1.7 years) had multiple recurrences of syncope despite therapy. Non-cardiac symptoms include sensorineural hearing loss in 100% of cases and hypochromic anemia in 75% of cases.Conclusion. In Jervell-Lange-Nielsen patients who are characterized by resistant ventricular tachyarrhythmia aggressive antiarrhythmic therapy at a very early age is essential for increasing the risk of life-threatening cardiac events. Consequently, diagnosis of the disease in the first days of life is extremely relevant. ECG screening is crucial in solving the problem of early diagnosis of the disease. Extracardiac pathology in patients with Jervell-Lange-Nielsen syndrome necessitates the interaction of doctors of different specialties together when managing a patient.

Endoglin deficiency elicits hypoxia-driven congestive heart failure in zebrafish.

Hereditary hemorrhagic Telangiectasia (HHT) also known as Rendu-Osler-Weber syndrome is a rare genetic disease relying on mutations affecting components of TGF-β/BMP signaling pathway in endothelial cells. This disorder is characterized by vascular dysplastic lesions or arterio-venous malformations prone to rupture and ensuing hemorrhages are thought to be responsible for iron deficiency anemia. Along with Activin receptor-like kinase ALK1, Endoglin (CD105) is involved in the vast majority of reported HHT cases. Unlike Type-1 TGF-β Receptor ALK1, Endoglin is not endowed with Ser/Thr kinase activity but serves as an ancillary receptor that modulates TGF-β receptor complex signaling. In this report, we characterized zebrafish endoglin locus and demonstrated that it produces two phylogenetically conserved protein isoforms using a distinctive alternative splicing mechanism. This preliminary work served as a base to the establishment of a Crispr/Cas9 engineered Endoglin mutant line from which functional analysis revealed that Endoglin deficiency results in massive fish death during the course from juvenile stage to adulthood. Endoglin deficient fish develop a cardiomegaly resulting in heart failure and hypochromic anemia which both stem from chronic hypoxia. A combination of histological analysis and confocal imaging evidenced structural alterations of the developing gill and its underlying vascular architecture that tally with respiratory distress and hypoxemia/hypoxia occurrence. Finally, phenylhydrazine treatment demonstrated that lowering hematocrit/blood viscosity constraint strongly alleviates heart failure and enhances survival of Endoglin deficient fish. Altogether our data support the notion that zebrafish Endoglin is crucial for gill proper development and respiratory function and that further studies using zebrafish in general and this endoglin mutant in particular will provide crucial hints of molecular and cellular events altered in HHT for the development of new therapeutic strategies.