Anemia in female adolescents]

Investigations for exploring the frequency and pathogenesis of anaemia were carried out in 164 female pupils of a minicipal grammar school for girls aged from 14 to 20 years. There were lowered haematocrit values below 37% in 81 cases (49%), which were due to iron deficiency in 31 girls. Only in one case a lowered vitamin B12 level was detected and in 8 girls there was a lowered folic acid content in the serum. The frequency of anaemia in girls of school age mainly caused by iron deficiency is emphasized.     

Characteristics of the pathways of erythroid cell differentiation in birds in anemia

A comparative study has been made of erythroid cell development pathways in the peripheral blood of pigeons during severe, moderate and weak forms of anaemia. Three modes of erythrocyte formation from bone marrow precursor are described: 1. A reserve erythropoiesis--the principal process during severe anaemia; the bone marrow precursors are basophylic erythroblasts which are reversibly blocked in phase G2 of the cell cycle; in results the rapid, increase of erythrocyte population above the normal level, although the cells have 25-30 per cent deficiency in haemoglobin content. 2) A mode of erythropoiesis, whose precursors are proliferating polychromatophylic erythroblasts; this is the principal mode of erythropoiesis at the moderate anaemia, leading to restoration of the normal quantity of erythrocytes with a normal haemoglobin content. 3) A mode of erythropoiesis with proliferating orthochromatic erythroblasts being precursors (which do not divide normally); this is the principal mode during the weak anaemia to result in a slow restoration of the number of erythrocytes with an excess in haemoglobin content. It is shown that regulation of the restoration processes during anaemia are characterized by a specific combination of cell proliferation and differentiation.     

Prevalence and Risk Factors of Anaemia among Children Aged between 6 Months and 14 Years in Kenya

Background

Anaemia is one of the significant public health problems among children in the world. Understanding risk factors of anaemia provides more insight to the nature and types of policies that can be put up to fight anaemia. We estimated the prevalence and risk factors of anaemia in a population-based, cross-sectional survey.

Methodology

Blood samples from 11,711 children aged between 6 months and 14 years were collected using a single-use, spring-loaded, sterile lancet to make a finger prick. Anaemia was measured based on haemoglobin concentration level. The generalized linear model framework was used to analyse the data, in which the response variable was either a child was anemic or not anemic.

Results

The overall prevalence of anaemia among the children in Kenya was estimated to be 28.8%. The risk of anaemia was found to decrease with age progressively with increase in each year of age; children below 1 year were at highest risk of anaemia. The risk of anaemia was significantly higher in male than female children. Mothers with secondary and above education had a protective effect on the risk of anaemia on their children. Malaria diagnosis status of a child was positively associated with risk anaemia.

Conclusion

Controlling co-morbidity of malaria and improving maternal knowledge are potential options for reducing the burden of anaemia.     

Disparity between dietary iron intake and iron status of children aged 10-12 years

Iron status was assessed in a representative sample of 188 adolescents living in a medium-sized city in Poland. Dietary intakes were evaluated using records of diet over a period of seven consecutive days. Subjects were considered to be iron deficient when two or more of the following parameters were abnormal: serum ferritin, transferrin saturation or mean corpuscular haemoglobin concentration. Based on this definition, the prevalence of iron deficiency in the investigated sample of children aged from ten to twelve years was 12.7%. Iron deficiency anaemia was defined using the following criteria: haemoglobin values less than 12.0 g. dl (-1) in girls or less than 12.2 g. dl(-1) in boys, combined with an iron deficiency. With such a definition, the prevalence of iron deficiency anaemia in all subjects was 6.3%. Four boys (3.9%) and six girls (6.8%) were diagnosed as anaemic. The values for Hb in the anaemic boys ranged from 10.9 to 12.2 g. dl (-1) and in anaemic girls from 8.7 to 12.0 g. (-1). It was found that the majority of the individuals studied had a dietary haem-iron intake lower than that recommended. No relationship was found between the level of serum ferritin and total iron and vitamin C dietary intake, but there was positive correlation between serum ferritin and intake of haem iron. A seven-day dietary history questionnaire correctly identified children at risk of iron deficiency anaemia.     

Sickle-cell Anaemia,Sickle-cell Thalassaemia,Sickle-cell Haemoglobin C Disease,and Asymptomatic Haemoglobin C Thalassaemia in one Ghanaian Family

A Ghanaian family is described in which a sickle-cell haemoglobin C man married to a sickle-cell thalassaemia woman produced 12 children (eight alive). Four children have sickle-cell anaemia, two sickle-cell haemoglobin C disease, one has sickle-cell thalassaemia, and one is asymptomatic haemoglobin C thalassaemia.It is emphasized that the contribution that adult sickle-cell disease patients make, through procreation, to the persistence of the S gene may be greater than is normally supposed, and that this contribution may soon outstrip that made by balanced polymorphism through falciparum malaria. Widespread haemoglobin genotyping in schools leading to genetic counselling is advocated to decrease the incidence of sickle-cell disease.     

Appropriateness of the current parasitological control target for hookworm morbidity: A statistical analysis of individual-level data

BackgroundSoil-transmitted helminths affect almost 2 billion people globally. Hookworm species contribute to most of the related morbidity. Hookworms mainly cause anaemia, due to blood loss at the site of the attachment of the adult worms to the human intestinal mucosa. The World Health Organization (WHO) aims to eliminate hookworm morbidity by 2030 through achieving a prevalence of moderate and heavy intensity (M&HI) infections below 2%. In this paper, we aim to assess the suitability of this threshold to reflect hookworm-attributable morbidity.Methodology/Principal findingsWe developed a hierarchical statistical model to simulate individual haemoglobin concentrations in association with hookworm burdens, accounting for low haemoglobin values attributable to other causes. The model was fitted to individual-level data within a Bayesian framework. Then, we generated different endemicity settings corresponding to infection prevalence ranging from 10% to 90% (0% to 55% M&HI prevalence), using 1, 2 or 4 Kato-Katz slides. For each scenario, we estimated the prevalence of anaemia due to hookworm. Our results showed that on average, haemoglobin falls below the WHO threshold for anaemia when intensities are above 2000 eggs per gram of faeces. For the different simulated scenarios, the estimated prevalence of anaemia attributable to hookworm ranges from 0% to 30% (95%-PI: 24% - 36%) being mainly associated to the prevalence of M&HI infections. Simulations show that a 2% prevalence of M&HI infections in adults corresponds to a prevalence of hookworm-attributable anaemia lower than 1%.Conclusions/SignificanceOur results support the use of the current WHO thresholds of 2% prevalence of M&HI as a proxy for hookworm morbidity. A single Kato-Katz slide may be sufficient to assess the achievement of the morbidity target. Further studies are needed to elucidate haemoglobin dynamics pre- and post- control, ideally using longitudinal data in adults and children.     

Sickle cell-beta 0-thalassaemia in Saudi Arabia

During an extensive investigation to determine the frequency of sickle cell and thalassaemia genes in the Saudi population, 22 cases with S/beta 0-thalassaemia were identified and the haematological, biochemical and clinical findings were compared with those in patients with sickle cell anaemia. The values of mean cell volume, mean cell haemoglobin and packed cell volume were found to be lower while all other haematological parameters including Hb A2 were higher in the S/beta 0-thalassaemia group. No statistically significant difference in the Hb F level was found between the two groups. Biochemical parameters were grouped according to organ function tests. Only slight differences were seen in the values of some parameters. The clinical data showed that, in general, patients with sickle cell anaemia had a more severe condition than the S/beta 0-thalassaemia.     

Determination of haemoglobin A(1c) by liquid chromatography using a new cation-exchange column

The use of a new cation-exchange column, ProPac SCX-10, for the determination of haemoglobin A(1c) (HbA(1c)) by high-performance liquid chromatography is described. After optimization of the analytical method for the separation of the various isoforms of haemoglobin with the ProPac SCX-10 column, the method was applied to the determination of HbA(1c) in blood from 59 volunteers. Three of the 59 had previously been diagnosed as diabetics. Interference studies for carbamylation, acetylation and pre-HbA(1c) were carried out via "in-vitro" experiments. No interference due to carbamylation was observed at the urea values normally found in uremic patients undergoing dialysis. No interference from pre-HbA(1c) was detected either. The method is able to separate haemoglobin A (alpha(2)beta(2)), haemoglobin S (haemoglobin from sickle cell anaemia patients) and haemoglobin A(2) (alpha(2)delta(2)) without interference. The method of Hampel was applied to detect outliers. A value of 3.29+/-0.44% (2sigma) for HbA(1c) was obtained in the analysis of 56 blood samples from non-diabetics. This average value is lower than that reported by most of the methods currently used in routine analyses.     

Accuracy and Reliability of Pallor for Detecting Anaemia: A Hospital-Based Diagnostic Accuracy Study

Background

Anaemia is a common disorder. Most health providers in resource poor settings rely on physical signs to diagnose anaemia. We aimed to determine the diagnostic accuracy of pallor for anaemia by using haemoglobin as the reference standard.

Methodology/Principal Findings

In May 2007, we enrolled consecutive patients over 12 years of age, able to consent and willing to participate and who had a haemoglobin measurement taken within a day of assessment of clinical pallor from outpatient and medicine inpatient department of a teaching hospital. We did a blind and independent comparison of physical signs (examination of conjunctivae, tongue, palms and nailbed for pallor) and the reference standard (haemoglobin estimation by an electronic cell counter). Diagnostic accuracy was measured by calculating likelihood ratio values and 95% confidence intervals (CI) at different haemoglobin thresholds and area under the receiver operating characteristic curve. Two observers examined a subset of patients (n = 128) to determine the inter-observer agreement, calculated by kappa statistics. We studied 390 patients (mean age 40.1 [SD 17.08] years); of whom 48% were women. The haemoglobin was <7 g/dL in 8% (95% confidence interval, 5, 10) patients; <9 g/dL in 21% (17, 26) patients and <12 g/dL in 64% (60, 70) patients. Among patients with haemoglobin <7 g/dL, presence of severe tongue pallor yielded a LR of 9.87 (2.81, 34.6) and its absence yielded a LR of 0. The tongue pallor outperformed other pallor sites and was also the best discriminator of anaemia at haemoglobin thresholds of 7 g/dL and 9 g/dL (area under the receiver operating characteristic curves (ROC area  = 0.84 [0.77, 0.90] and 0.71[0.64, 0.76]) respectively. The agreement between the two observers for detection of anaemia was poor (kappa values  = 0.07 for conjunctival pallor and 0.20 for tongue pallor).

Conclusions/Significance

Clinical assessment of pallor can rule out and modestly rule in severe anaemia.     

Contraception and Unintended Pregnancy among Unmarried Female University Students: A Cross-sectional Study from China

This study aims to understand the level of contraceptive knowledge and attitudes towards contraception, and then to explore the association between the contraceptive behavior and unintended pregnancy in unmarried female university students in China. A cross-sectional study was conducted of university students in 49 universities across 7 cities in China from September 2007 to January 2008. We distributed 74,800 questionnaires, of which 69,842 were returned. In this paper, the data from 35,383 unmarried female university students were analyzed. The prevalence of sexual intercourse in unmarried female university students was 10.2%. The prevalence of unintended pregnancy in those sexually active female university students, was 31.8%. Among students with pregnancy, 53.5% experienced two or more pregnancies. 28.3% of the students with sexual intercourse reported that they always adopted contraceptive methods, and of those 82.9% chose to use male condoms. The majority (83.9%) of students with unintended pregnancy chose to terminate the latest pregnancy by surgical abortion or medical abortion. The contraceptive knowledge level of students who experienced unintended pregnancy was lower than those who did not. In China, about one third of unmarried female students with sexual intercourse experience unintended pregnancy. A variety of contraceptive methods are adopted, but the frequency of contraceptive use is low. Most of unmarried female students who experienced unintended pregnancy would choose to terminate the pregnancy with surgical or medical abortion. University students, especially the ones who have experienced unintended pregnancy, lack contraceptive and reproductive health knowledge.     

Further Observations on the Relation between Iron and Folate Status in Pregnancy

This study was planned to determine whether iron deficiency in pregnancy predisposed to the development of folate deficiency and also the smallest daily iron supplement that maintained haemoglobin levels in pregnancy.Three groups of women were given oral ferrous fumarate supplying 30, 60, and 120 mg of iron; a fourth group was given 1 g of parenteral iron in early pregnancy followed by oral iron (60 mg); a fifth group received a placebo. Tablets were taken once daily.Oral iron 30 mg once daily maintained haemoglobin levels throughout pregnancy. Women whose marrows lacked demonstrable iron at the 37th week had a significantly higher incidence of megaloblastic haemopoiesis (28·7%) than those with demonstrable iron stores (15·3%); women taking oral iron did not have a lower frequency of megaloblastosis than those given a placebo. We concluded that iron does not have a direct effect on folate status in pregnancy, that the association of iron deficiency and megaloblastic anaemia in pregnancy is the result of poor nutrition, and that there is no cause-and-effect relation between them.     

Anaemia as a prognostic factor for the therapeutic effect of radiosensitizers

Results are reported of a clinical trial on the effect of metronidazole as an adjuvant radiosensitizer in the radiation treatment of cervix carcinomas in advanced stages. Analysis of the results was made with regard to the local clearance of the tumour and with haemoglobin level as a stratifying factor (less than 120 g/l or greater than/equal to 120 g/l at presentation). With no metronidazole treatment, the results in anaemic patients were inferior in comparison to patients with normal haemoglobin level. Metronidazole significantly improved the results in the anaemic cases, but had no effect on the non-anaemic patients. Without stratification with respect to anaemia, no significant difference between the metronidazole-treated and untreated control group was noted. It is concluded that anaemia has a prognostic value, and anaemic patients may represent a particular group for which hypoxic cell sensitizers can be expected to improve the effect of radiotherapy.     

Faecal blood loss in response to exercise.

Recently qualitative tests have indicated that gastrointestinal bleeding during exercise may be an important contributory factor in sports anaemia. In six healthy men who walked 37 km on four consecutive days faecal haemoglobin content remained normal (reference range 0.10-2.53 mg/g faeces) with no significant differences between values. In 28 marathon runners who refrained from taking drugs or food containing blood the median faecal haemoglobin content increased by 0.42 mg/g faeces (95% confidence interval 0.12 to 0.83 mg/g) from 1.06 (0.86 to 1.31) mg/g before the race. In 13 runners who had taken drugs before the race the corresponding increase in the median faecal haemoglobin content was 0.87 (-0.03 to 2.20) mg/g from the value before the race of 0.93 (0.46 to 1.55) mg/g. Prolonged walking had no effect on gastrointestinal blood loss. Intense endurance exercise in the form of marathon running induced a significant but clinically unimportant increase. This may be exaggerated by the ingestion of drugs and assume importance in causing iron deficiency and sports anaemia. The use of drugs, particularly analgesics, by marathon runners should be actively discouraged.     

Non-Invasive Detection of Anaemia Using Digital Photographs of the Conjunctiva

ResultsConjunctival EI was reproducible between images (average coefficient of variation 2.96%). EI of the palpebral conjunctiva correlated more strongly with haemoglobin concentration than that of the forniceal conjunctiva. Using the compact camera, palpebral conjunctival EI had a sensitivity of 93% and 57% and specificity of 78% and 83% for detection of anaemia (haemoglobin < 110 g/L) in training and internal validation sets, respectively. Similar results were found using the iPhone camera, though the EI cut-off value differed. Conjunctival EI analysis compared favourably with clinician assessment, with a higher positive likelihood ratio for prediction of anaemia.ConclusionsErythema index of the palpebral conjunctiva calculated from images taken with a compact camera or mobile phone correlates with haemoglobin and compares favourably to clinician assessment for prediction of anaemia. If confirmed in further series, this technique may be useful for the non-invasive screening for anaemia.     

Sexual behaviours and contraception among university students in Turkey

The aim of this study was to evaluate the sexual attitudes and behaviours of university students. An anonymous questionnaire was administered to 550 final-year university students aged 20-25 years in Izmir, Turkey. Male students opposed premarital sexual intercourse for both genders more than female students did. The frequency of sexual intercourse among male students (61.2%) was higher than that among female students (18.3%). The mean age of first sexual intercourse was lower among male than among female respondents. The rate of condom use at first sexual intercourse was 47.4%. The frequency of having two or more past sexual partners and masturbation was higher among males than females. It was found that there were culture-specific and gender-dependent differences in sexual attitudes and behaviours of the university students. These results may help in the planning of education and health policies in Turkey.     

Association between NAD+ levels and anaemia among women in community‐based study

Nicotinamide adenine dinucleotide (NAD⁺) level is the protective factor of cardiovascular diseases (CVDs). In addition, anaemia is a risk factor of adverse cardiovascular outcomes in women. However, there are limited data about the association between NAD⁺ and anaemia. The aim of this study was to evaluate association of NAD⁺ with anaemia among women. A total of 727 females from Jidong community were included in the current analysis. NAD⁺ levels were tested by the cycling assay and HPLC assay using whole blood samples. Anaemia was determined by haemoglobin (Hb) concentration, and the subtypes of anaemia were further defined according to mean corpuscular volume (MCV) in blood. Multivariable logistic analysis was used to analyse the association between NAD⁺ levels and anaemia or its subtypes. The mean age of recruited subjects was 42.7 years. The proportion of anaemia by NAD⁺ levels quartiles were 19.7% (35/178), 4.8% (9/189), 3.4% (6/178) and 2.7% (5/182). Haematological parameters including haemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and red blood count (RBC) increased over NAD⁺ quartiles. Red cell volume distribution width (RDW) decreased over NAD⁺ quartiles. Compared with the lowest quartile of NAD⁺ levels (<27.6μM), the adjusted odds ratios with 95% confidence intervals of the top quartile were 0.15 (0.06–0.41) for anaemia, 0.05 (0.01–0.36) for microcytic anaemia and 0.37 (0.10–1.36) for normocytic anaemia respectively. Higher NAD⁺ levels were significantly associated with lower prevalence of anaemia among women, especially microcytic anaemia and normocytic anaemia. Haematological parameters might serve as a predictor of the blood NAD⁺ levels.     

Improvement of anaemia in haemodialysed patients after viral or toxic hepatic cytolysis.

Thirty patients receiving haemodialysis, including two who had undergone bilateral nephrectomy, showed significant increases (p less than 0.001) in packed cell volume, haemoglobin concentration, and reticulocyte count during an episode of viral or toxic liver cytolysis. In 19 cases the episode lasted a mean of 5.0 +/- SD 2.9 months and was accompanied by improved haematological values for a mean of 12.0 +/- 6.0 weeks. Of the remaining patients, in whom the episode lasted a mean of 8.0 +/- 3.5 months (p less than 0.02), seven showed continued improvement a mean of 30.0 +/- 16.0 weeks after cytolysis. In eight patients in this group there was an apparent correlation between persistently increased haemoglobin concentrations and biopsy evidence of chronic hepatitis. The findings suggest that the reduction in anaemia resulted from enhanced red-cell production mediated by secretion of erythropoietin from regenerating liver cells. If confirmed this might have important implications for the treatment of anaemia in chronic renal insufficiency.     

Glycated haemoglobin and metabolic control of diabetes mellitus: external versus locally established clinical targets for primary care.

OBJECTIVES--To examine current targets for glycated haemoglobin as a marker for metabolic control in diabetes mellitus in relation to datasets from several areas, and to consider whether target setting could be improved. DESIGN--Data collected from enhanced care records of general practices for a representative community based sample of people with diabetes. SETTING AND SUBJECTS--3022 people with diabetes on the lists of 37 general practices (total list size 222,550) in South Glamorgan in 1992; samples of glycated haemoglobin had been processed at two laboratories with different methodologies and reference ranges. MAIN OUTCOME MEASURES--Last glycated haemoglobin level measured in subjects for 1992 and published data from other studies considered in relation to existing goals and standards for the metabolic control of diabetes. RESULTS--An ascertainment rate for people with diabetes of 1.36% was obtained. The rate of data capture for haemoglobin A1 was 75.7%, and the mean level for study samples was 10.5% at one laboratory and 10.0% at the other (similar values to those of comparable studies). These mean levels of haemoglobin A1 in representative populations of people with diabetes are poor or very poor according to published standards, including those of the British Diabetic Association. These findings are set in the context of the psychology of goal setting and performance in complex clinical situations. CONCLUSION--Targets for clinical care that are set in the absence of normative data and local feasibility assessments should be treated with caution. Targets are more likely to enhance health care if target setters recognise the importance of psychological aspects of goal setting and motivation.     

The development and role of international biological reference materials in the diagnosis of anaemia

Anaemia is a major global health problem. Although the main cause is iron deficiency, anaemia also results from other nutritional deficiencies (folate and vitamin B₁₂), haemolytic disorders including haemoglobinopathies, and bone marrow disorders. Accurate diagnosis of anaemia is dependent on reliable diagnostic tests and reference ranges, which in turn are dependent on effective standardisation. Standardisation is achieved through the availability of reference materials and reference measurement procedures. International biological reference materials have therefore been developed to standardise and control diagnostic tests for anaemia for a diverse range of analytes including total haemoglobin and haemoglobin types, ferritin, the serum transferrin receptor, serum vitamin B₁₂ and folate, whole blood folate, and alloantibodies which mediate immune haemolytic anaemia.     

Some haematological responses of normal and splenectomized rainbow trout Salmo gairdneri to a 12% blood loss

Anaemia can be induced in Rainbow trout by removing 12 % of the blood volume by cardiac puncture. Recovery from such an anaemia has been monitored in both normal and splenectomized fish. After the bleeding there is a decrease in red cell numbers, haematocrit and blood haemoglobin concentration. Although recovery in normal trout was not complete within 27 days, which was the period of the observations, it was seen as a replenishing of red cell numbers, haematocrit and blood haemoglobin concentration. Mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC), both depressed by the bleeding, did not appear to recover during the experimental period.
Splenectomy reduced erythropoietic intensity. After bleeding all the parameters studied were more depressed than those found in normal trout, and recovery was not noted. Blood haemoglobin and red cell numbers did not have the same post-bleeding pattern as normal individuals; MCH and MCHC values remained markedly depressed.
Splenic involvement was further demonstrated by bleeding trout for a second time from both normal and splenectomized groups. In contrast to the response of normal animals, there was a further deterioration of red cell numbers and blood haemoglobin concentration in splenectomized individuals.