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Background: This case describes chronic anemia of a late preterm infant secondary to maternal-fetal hemorrhage and subsequent findings of maternal choriocarcinoma. Clinical Findings: This infant was born at 35 6/7 weeks gestational age via cesarean section for non-reassuring fetal heart tones. The mother presented with decreased fetal movement and the biophysical profile was 4/8. Following delivery, the infant did not require respiratory support, was vigorous with extreme pallor, and had a hemoglobin of less than 5 on cord gas. Primary Diagnosis: Chronic anemia secondary to fetomaternal hemorrhage. Interventions: The infant's initial hemoglobin was 2.4 and hematocrit was 8.1. The mother's Kleihauer-Betke test was elevated at 7%. The infant required a partial exchange transfusion following admission to the neonatal intensive care unit. Following the partial exchange transfusion, the infant began to experience increasing respiratory distress and required respiratory support. An echocardiogram showed severe persistent pulmonary hypertension of the neonate. The mother was subsequently diagnosed with choriocarcinoma. Outcomes: The infant fully recovered from chronic anemia and persistent pulmonary hypertension of the neonate and was discharged home with the mother. The infant required follow-up testing for choriocarcinoma outpatient. Practice Recommendations: Newborns diagnosed with early chronic anemia should be evaluated, the cause investigated, and appropriate treatment considered. If the cause of blood loss is unknown, a maternal Kleihauer-Betke test should be considered. In this case, a partial exchange transfusion was performed to avoid cardiovascular volume overload, but another course of treatment could include small aliquots of packed red blood cell transfusions. [ABSTRACT FROM AUTHOR]

Anemia and hypoxemia are common clinical conditions that are difficult to study and may impact pulse oximeter performance. Utilizing an in vitro circulation system, we studied performance of three pulse oximeters during hypoxemia and severe anemia. Three oximeters including one benchtop, one handheld, and one fingertip device were selected to reflect a range of cost and device types. Human blood was diluted to generate four hematocrit levels (40%, 30%, 20%, and 10%). Oxygen and nitrogen were bubbled through the blood to generate a range of oxygen saturations (O2Hb) and the blood was cycled through the in vitro circulation system. Pulse oximeter saturations (SpO2) were paired with simultaneously-measured O2Hb readings from a reference CO-oximeter. Data for each hematocrit level and each device were least-squares fit to a 2nd-order equation with quality of each curve fit evaluated using standard error of the estimate. Bias and average root mean square error were calculated after correcting for the calibration difference between human and in vitro circulation system calibration. The benchtop oximeter maintained good accuracy at all but the most extreme level of anemia. The handheld device was not as accurate as the benchtop, and inaccuracies increased at lower hematocrit levels. The fingertip device was the least accurate of the three oximeters. Pulse oximeter performance is impacted by severe anemia in vitro. The use of in vitro calibration systems may play an important role in augmenting in vivo performance studies evaluating pulse oximeter performance in challenging conditions.

Jehovah's Witnesses is a Christian denomination widely recognized for their steadfast refusal of blood transfusions, even when facing severe anemia. We describe a unique case of a 42-year-old Jehovah's Witness woman with severe iron deficiency anemia. She necessitated surgical correction of a malpositioned gastric band within the context of a complex necrotizing aspiration pneumonia secondary to esophageal obstruction. Medical management of this severe anemia has been a challenge as traditional approaches, like a blood transfusion, are not possible. Instead, a multifaceted approach has been described with intravenous iron infusions, recombinant human erythropoietin, vitamin B12, folate, and vitamin C administration. We emphasize the lack of consensus on guideline protocols regarding management of severe anemia for Jehovah's Witness patients and the subsequent need for more investigation into that matter. It also underscores the significance of respecting patient autonomy through close collaboration between patients and their health care providers to ensure effective patient-centered care. [ABSTRACT FROM AUTHOR]

Abstract Background Uterine inversion is a clinical condition characterized by the folding of the uterine fundus into the uterine cavity or beyond the cervix. Chronic uterine inversions that manifest seven years after delivery are extremely rare, despite the fact that both acute and chronic uterine inversions are infrequent. Unlike uterine inversion during parturition, which can be promptly managed, chronic uterine inversion poses a diagnostic and management challenge. We, herein, report a patient who was managed and followed at our institution for chronic uterine inversion. Case presentation A 28-year-old African female who was referred to our institution with complaints of secondary infertility for seven years, abnormal vaginal bleeding, and lower abdominal pain for 12 months with a mass-like sensation in the vagina. At presentation, she had pale conjunctiva and a protruded, rubbery mass in the cervix with indistinguishable cervical OS on vaginal examination. The patient was resuscitated with intravenous fluids and three units of blood, after which Haultain’s procedure was performed. After 16 months on a contraceptive, she was able to conceive and deliver a healthy neonate. Conclusion Severe anemia can rarely be a presenting symptom of chronic uterine inversion. Following a surgical procedure for chronic uterus inversion, a successful delivery is possible if thorough follow-up is carried out.

Pure red cell aplasia (PRCA) is characterized by severe anemia with reticulocytopenia and bone marrow erythroblastopenia. The early erythroblasts are markedly decreased; however, in rare instances, they may be normal or raised in number. There are varied etiologies, namely congenital or acquired and primary or secondary. The congenital PRCA is known as “Diamond-Blackfan anemia.” Thymomas, autoimmune disease, lymphomas, infections, and drugs also may be familiar associates. However, the etiologies of PRCA are numerous, and many diseases/infections can be associated with PRCA. The diagnosis rests on clinical suspicion and appropriate laboratory workup. We evaluated nine cases of red cell aplasia, having severe anemia with reticulocytopenia. Nearly half of the cases showed adequate erythroid (> 5% of the differential count) but with a maturation arrest. The adequacy of the erythroid could confuse the hematologist and may even delay the diagnosis. Hence, it is empirical that PRCA could be considered a differential in every case of severe anemia with reticulocytopenia, even in the presence of adequate erythroid precursors in the bone marrow.

Background: Anemia in pregnancy remains a worldwide public health problem, particularly affecting developing countries. It is observed to be associated with multitudes of both maternal and fetal complications. The present study was undertaken to study the prevalence of severe anemia in pregnancy and assess the associated adverse maternal and fetal outcomes. Materials and methods: A total of 680 patients diagnosed with severe anemia in pregnancy during the study period were included and relevant parameters were analyzed. Results: The prevalence of severe anemia was 4.4%, with 21.80% of those having very severe anemia. Preterm labor (26.2%) was the most common adverse maternal outcome, followed by preeclampsia/eclampsia (10.3%), sepsis (6.5%), and wound gape (5%). Low birth weight (LBW)-intrauterine growth restriction (IUGR) (45.0%) was the commonest adverse fetal outcome, followed by LBW-prematurity (28.8%), birth asphyxia (6.1%), and intrauterine device (IUD)/stillbirth (3.3%). Associated risk factors were rural residence (60.4%), referral from periphery (59.3%), lower socioeconomic status (89.1%), unbooked pregnancy (76.2%), multigravida (63.8%), and no iron/folic acid supplementation during pregnancy (44.7%). Conclusion: Severe anemia in pregnancy remains a major concern, both from the maternal and fetal point of view. Early detection and management are recommended to prevent adverse obstetric outcomes. [ABSTRACT FROM AUTHOR]

Postpartum hemorrhage (PPH) remains a significant obstetric emergency worldwide and a leading cause of maternal death. However, it is commonly underreported, which can represent a major concern for maternal morbidity and mortality. This retrospective case series study analyzed patients with red blood cell transfusion (RBCt) in the postpartum period over a four-year interval at a specific center. A total of 18,674 patients delivered between January 2018 and December 2021. Patients with postpartum RBCt were classified into two groups: those with identified PPH (i-PPH) and those without (non-i-PPH). Clinical variables, delivery details, blood loss data, and treatment information were collected. Statistical analysis involved a comparison of variables between the i-PPH and non-i-PPH groups. Univariate and multivariate analyses were performed, aiming to identify significant associations between the clinical variables and a lack of PPH identification. The incidence of RBCt was 1.26% (236 cases). Patients receiving RBCt had higher rates of cesarean delivery, twin pregnancy, labor induction, and previous cesarean section. Among patients with postpartum RBCt, 34.3% lacked an identified PPH. The rarity of postpartum RBCt contrasts with the increasing rates of PPH, highlighting the importance of diagnosing PPH and postpartum anemia. A strategy of systematic quantification of blood loss during delivery could help detect PPH and anemia before adverse consequences occur. [ABSTRACT FROM AUTHOR]

Patients with hemoglobinopathy may experience short-term benefits from nutritional support and blood transfusions, but long-term results may be better if a precise diagnosis is obtained and a precise course of treatment or safety measures is adopted. The goal of the study is to determine the prevalence of haemoglobin abnormalities in people who presented with moderate to severe anaemia using haemoglobin electrophoresis They will undergo haemoglobin electrophoresis to test for the presence of any haemoglobin abnormalities. For anaemia classification, the WHO reference range is used. The outcome and quality of life of patients with haemoglobin disorders can be improved when they are properly managed, and since a significant portion of the patients in our study have hemoglobinopathies of varying severity, it would be prudent to conduct investigations to determine the precise cause of anaemia, particularly in rural areas where supportive management remains the mainstay of treatment in most scenarios.

Background: Uterine inversion is a clinical condition characterized by the folding of the uterine fundus into the uterine cavity or beyond the cervix. Chronic uterine inversions that manifest seven years after delivery are extremely rare, despite the fact that both acute and chronic uterine inversions are infrequent. Unlike uterine inversion during parturition, which can be promptly managed, chronic uterine inversion poses a diagnostic and management challenge. We, herein, report a patient who was managed and followed at our institution for chronic uterine inversion. Case presentation: A 28-year-old African female who was referred to our institution with complaints of secondary infertility for seven years, abnormal vaginal bleeding, and lower abdominal pain for 12 months with a mass-like sensation in the vagina. At presentation, she had pale conjunctiva and a protruded, rubbery mass in the cervix with indistinguishable cervical OS on vaginal examination. The patient was resuscitated with intravenous fluids and three units of blood, after which Haultain's procedure was performed. After 16 months on a contraceptive, she was able to conceive and deliver a healthy neonate. Conclusion: Severe anemia can rarely be a presenting symptom of chronic uterine inversion. Following a surgical procedure for chronic uterus inversion, a successful delivery is possible if thorough follow-up is carried out. [ABSTRACT FROM AUTHOR]

Key Clinical Messages: Hereditary hemorrhagic telangiectasia (HHT), a rare hereditary disorder, can cause recurrent massive epistaxis and gastrointestinal bleeding leading to severe anemia. Early diagnosis of HHT is essential to provide timely interventional therapies. HHT is a rare autosomal dominant hereditary disease that results in abnormal vasculogenesis in the skin, mucous membranes, and visceral organs such as the liver, lungs, and brain. Clinical diagnosis of HHT is made using the Curacao criteria, which include recurrent spontaneous nosebleeds, mucocutaneous telangiectasias, visceral organ involvement, and first‐degree family history of HHT. Here, we report a patient with HHT from Ethiopia, who presented with recurrent epistaxis and gastrointestinal bleeding, and severe anemia requiring frequent blood transfusions as well as cauterization. The presented case is a 42‐year‐old Black Ethiopian man with frequent hospitalization for severe anemia and high‐output heart failure requiring frequent blood transfusions. His mother had bilateral epistaxis since her early adulthood. Physical examination was significant for tachycardia, pale conjunctivae, and tiny erythematous lesions over his tongue, ejection systolic murmur and peripheral edema. Laboratory investigations revealed severe anemia with iron deficiency picture. Upper gastrointestinal endoscopy showed multiple telangiectasia spots and abdominal Doppler ultrasound showed hepatic arterio‐venous malformations. He received supportive management and electrocauterization of nasal, gastric, and duodenal telangiectasias. To the best of our knowledge, this is the first case of HHT to be reported from Ethiopia. High degree of suspicion and early diagnosis of HHT is essential to start preventive screening and surveillance and provide timely interventional therapies. HHT can cause recurrent massive epistaxis and gastrointestinal bleeding leading to severe anemia and high‐output heart failure. In resource limited settings, selective cauterization of telangiectasia will help to control bleeding, although it does not avoid recurrent bleeding. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chicken infectious anemia (CIA) is caused by chicken anemia virus (CAV). Recently, severe anemia has emerged in layer chickens (8 to 10-week-old) on poultry farms in China. However, the etiological characteristics and pathogenic potential of CAV in chickens at 6 weeks or older are not well understood. In this study, we isolated a CAV strain, termed SD15, from two-month-old chicken with severe anemia and analyzed the genetic evolution relationship. We found that strain SD15 had the highest homology (98.9%) with CAV18 strain. Comparison with 33 reference strains revealed 16 amino acid mutations in strain SD15, two of which were previously unknown (F210S in VP1 and L25S in Vp3). Compared with low pathogenic strains (Cux-1 and C14), highly pathogenic strains (SDLY08 and SD15) had three basemutations in their noncoding region. To further understand its pathogenicity, 10-week-old specific-pathogen-free (SPF) chickens were challenged with the novel strain and SDLY08. No obvious clinical symptoms were observed in the SDLY08 group. However, SD15-infected chickens showed significant growth retardation and immunosuppression. Themainmanifestations of immunosuppression were the significantly reduced thymus and bursa indices and AIV-H9 vaccine-induced antibody levels (P < 0.05). The lowest number of red blood cells in the SD15 group was just 60% of that in the control group. Taken together, the novel strain SD15 not only showed higher pathogenicity but also exhibited the potential ability to break the age resistance of older chickens to CAV. Our study enhanced the understanding of the epidemiological characteristics of chickens infected with severe anemia and can facilitate the development of improved control strategies of CIA in China. [ABSTRACT FROM AUTHOR]

Pure red cell aplasia (PRCA) is characterized by severe anemia with reticulocytopenia and bone marrow erythroblastopenia. The early erythroblasts are markedly decreased; however, in rare instances, they may be normal or raised in number. There are varied etiologies, namely congenital or acquired and primary or secondary. The congenital PRCA is known as "Diamond-Blackfan anemia." Thymomas, autoimmune disease, lymphomas, infections, and drugs also may be familiar associates. However, the etiologies of PRCA are numerous, and many diseases/infections can be associated with PRCA. The diagnosis rests on clinical suspicion and appropriate laboratory workup. We evaluated nine cases of red cell aplasia, having severe anemia with reticulocytopenia. Nearly half of the cases showed adequate erythroid (> 5% of the differential count) but with a maturation arrest. The adequacy of the erythroid could confuse the hematologist and may even delay the diagnosis. Hence, it is empirical that PRCA could be considered a differential in every case of severe anemia with reticulocytopenia, even in the presence of adequate erythroid precursors in the bone marrow. [ABSTRACT FROM AUTHOR]

Background: Anemia is the most common nutritional disease in pregnancy with significant adverse maternofetal outcome. The objective of the present study is to study the impact of COVID-19 pandemic on the pregnancy outcomes of women with severe anemia. Methodology: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at LHMC and SSK Hospital, Delhi. The study included all antenatal women admitted at a gestational age of >26 weeks (third trimester) with severe anemia and hemoglobin level of 7 g/dL. In our study, a total of 4031 women were included as cases during study period (July to December 2022) and 6659 women as controls from pre-COVID-19 period (July to December 2019). Results: In present study, a total of 4031 women delivered during study period as compared to 6659 in control period. In the present study, the prevalence of anemia was observed to be 74.7% in the study group and 51.6% in the control group (P < 0.001). Mean hemoglobin level was significantly lower in study group as compared to the control groups P

Background: The present cross-sectional study was conducted to measure the population attributable risk (PAR) of severe anemia among children aged 6-23 months in the rural district of Kongoussi, in Burkina Faso. Methods: Socio-demographic, clinical, anthropometric, and biological data were collected from children and mothers. Results: In total, 671 children were included in the analysis, 50.4% of whom were male and 97.8% were breastfed. Only 5.8% of the children had adequate complementary feeding, 25.8% were wasted, and 23.5% stunted. Malaria affected about half (50.8%) of children; 39.3% had mild malaria and 11.5% had severe malaria. Children who were no longer breastfed were more likely to have malaria [OR = 3.98 (1.11-14.2), P = 0.022] than those who were breastfed. Fever in the last fortnight [OR = 1.49 (1.07-2.08), P = 0.019], current fever [OR = 4.30 (2.39-7.76), P < 0.001], and presence of splenomegaly [OR = 2.68 (1.54-4.67), P < 0.001] were also positively associated with malaria. Anemia and severe anemia had a prevalence of 96.8% and 24.4%, respectively, and were associated with both mild and severe malaria. Body mass index of mothers [OR = 1.82 (1.06-3.12), P = 0.029], diarrhea in the last fortnight [OR = 1.70 (1.06-2.71), P = 0.027], stunting [OR = 1.54 (1.01-2.34), P = 0.045], and splenomegaly [OR = 2.93 (1.70-5.06), P = 0.045] were other independent factors associated with severe anemia. The PARs of severe anemia due to mild and severe malaria were 22.1% (6.1%-35.4%) and 22.0% (11.6%-27.7%), respectively. Conclusion: Given the high frequency of anemia and severe anemia in this rural malaria-endemic area, interventions are required that consider the important contribution of malaria to anemia and aim to prevent infection.

Abstract Background Pure red cell aplasia (PRCA) is a hematological disorder characterized by anemia with severe reticulocytopenia caused by a marked reduction in erythroid precursors in the bone marrow. PRCA is known to be associated with pregnancy, but thymoma-associated PRCA during pregnancy is very rare, and its successful management has not been reported. Case presentation A 37-year-old primiparous woman with severe anemia was referred to our center at 27 weeks’ gestation. She was diagnosed with PRCA based on bone aspiration findings at 33 weeks’ gestation. Magnetic resonance imaging (MRI) revealed an anterior mediastinal mass 4 cm in size suspected of being thymoma. She was therefore diagnosed with thymoma-associated PRCA during pregnancy. Surgery for thymoma was planned after delivery, since the imaging findings were suggestive of early-stage thymoma (Masaoka stage I or II). With transfusion of a total 3,360 ml of red blood cells (RBCs) during pregnancy, the patient gave birth to a baby girl weighing 2,548 g at 40 weeks’ gestation. The baby showed transient congenital cutaneous candidiasis. The placental pathology revealed subamniotic inflammation with a fungal structure. Treatment with topical anti-fungal cream immediately ameliorated the baby’s skin lesion. Maternal anemia did not improve after delivery; however, the thymoma did not increase in size. At five months after delivery, the mother underwent thymectomy with oral cyclosporine A. A pathological examination revealed Masaoka stage II-a thymoma. She completely had recovered from anemia at six months after surgery. Cyclosporine A treatment was discontinued three years after surgery. Remission has been sustained for four years since surgery. Conclusions A very rare case of thymoma-associated PRCA during pregnancy was diagnosed without any subjective symptoms and was expectantly managed, resulting in a good prognosis. Although bone marrow aspiration during pregnancy is an invasive test, it is important to confirm the diagnosis. Conservative management with blood transfusion was possible for early-stage thymoma-associated PRCA during pregnancy. Active surveys, including MRI, for PRCA during pregnancy led to the detection of thymoma at an early stage and the achievement of a preferable pregnancy outcome.

Key Clinical Messages Hereditary hemorrhagic telangiectasia (HHT), a rare hereditary disorder, can cause recurrent massive epistaxis and gastrointestinal bleeding leading to severe anemia. Early diagnosis of HHT is essential to provide timely interventional therapies. Abstract HHT is a rare autosomal dominant hereditary disease that results in abnormal vasculogenesis in the skin, mucous membranes, and visceral organs such as the liver, lungs, and brain. Clinical diagnosis of HHT is made using the Curacao criteria, which include recurrent spontaneous nosebleeds, mucocutaneous telangiectasias, visceral organ involvement, and first‐degree family history of HHT. Here, we report a patient with HHT from Ethiopia, who presented with recurrent epistaxis and gastrointestinal bleeding, and severe anemia requiring frequent blood transfusions as well as cauterization. The presented case is a 42‐year‐old Black Ethiopian man with frequent hospitalization for severe anemia and high‐output heart failure requiring frequent blood transfusions. His mother had bilateral epistaxis since her early adulthood. Physical examination was significant for tachycardia, pale conjunctivae, and tiny erythematous lesions over his tongue, ejection systolic murmur and peripheral edema. Laboratory investigations revealed severe anemia with iron deficiency picture. Upper gastrointestinal endoscopy showed multiple telangiectasia spots and abdominal Doppler ultrasound showed hepatic arterio‐venous malformations. He received supportive management and electrocauterization of nasal, gastric, and duodenal telangiectasias. To the best of our knowledge, this is the first case of HHT to be reported from Ethiopia. High degree of suspicion and early diagnosis of HHT is essential to start preventive screening and surveillance and provide timely interventional therapies. HHT can cause recurrent massive epistaxis and gastrointestinal bleeding leading to severe anemia and high‐output heart failure. In resource limited settings, selective cauterization of telangiectasia will help to control bleeding, although it does not avoid recurrent bleeding.

Copyright of Revista Salud UIS is the property of Universidad Industrial de Santander and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Wilson Saputra Wijaya,1 Ika Krisnawati2 1Faculty of Medicine, Trisakti University, Jakarta, Indonesia; 2Department of Cardiology, Tangerang City General Hospital, Tangerang City, IndonesiaCorrespondence: Wilson Saputra Wijaya, Faculty of Medicine, Trisakti University, Jakarta, Indonesia, Tel +62 811 113 938, Email werewilsonsw@gmail.comIntroduction: Brugada syndrome (BrS) has been described as an inherited cardiac disorder due to gene mutations, which contributes to sudden cardiac death, especially in Southeast Asians. Brugada phenocopy, which has the same pattern caused by etiologies such as metabolic disorder, is potentially reversible and avoids unnecessary implantable medical devices.Case Presentation: We reported a rare case of Brugada phenocopy in a 60-years-old Indonesian male with severe anemia and a history of chronic urinary tract bleeding and hemorrhoid. Brugada phenocopy, widely known as BrS look-alike, has been linked to sodium, potassium, and calcium channel dysfunction. This condition is uncommon and has been related to metabolic conditions such as anemia. Iron deficiency anemia induces ischemia in the myocardium and degrades the calcium channels. During the transfusion, hypocalcemia precipitates temporary arrhythmia with right ventricular outflow tract origin, which reverts after the hypocalcemia has been treated.Conclusion: Due to the possibility of altered ion channels and how rarely hypocalcemia induces arrhythmia, this makes understanding the pathogenesis of Brugada phenocopy essential. Though caution is necessary, early recognition can improve prognosis as Brugada phenocopy is potentially reversible.Keywords: Brugada phenocopy, severe anemia, calcium channel, right ventricular outflow tract

Abstract Background Postpartum spontaneous vulvar hematoma is a rare complication of childbirth that can potentially cause maternal death if not managed properly and in a timely manner. Case summary We present the case of maternal near miss secondary to postpartum hemorrhage secondary to vulvar hematoma after home delivery in a 28-year-old para IV mother from rural Ethiopia. The case was surgically managed under spinal analgesia. The mother and her newborn were discharged on the fourth postprocedure day. Conclusion Neglected and inappropriately managed postpartum vulvar hematoma can cause significant maternal morbidity; therefore, timely surgical exploration, ligation of bleeding vessels, and obliteration of dead space can avert severe maternal complications

Anemia is a modifiable risk factor for postoperative complications following surgery. This study aimed to determine the impact of preoperative anemia severity on 30-day postoperative complications following adult spinal deformity (ASD) surgery. Adults undergoing spinal fusion for ASD from 2012 to 2018 were identified in the National Surgical Quality Improvement Program database. Patients were substratified into 3 cohorts–non-anemia, mild anemia, and moderate-to-severe anemia–based on World Health Organization definitions. We assessed 30-day wound, cardiac, pulmonary, renal, and thromboembolic complications, as well as sepsis, mortality, postoperative transfusions, extended length of stay, and reoperation. Bivariate analyses and multivariable logistic regression were performed. Of 2173 patients, 1694 (78%) had no anemia, 307 (14%) had mild anemia, and 172 (8%) had moderate or severe anemia. Following adjustments, patients with mild anemia were more likely to have postoperative blood transfusions (odds ratio [OR] 1.80, P < 0.001) and extended length of stay (OR 1.43, P < 0.001). Patients with moderate-to-severe anemia were at increased risk of organ space infection (OR 3.27, P = 0.028), death (OR 13.15, P = 0.001), postoperative blood transfusion (OR 2.81, P < 0.001), and extended length of stay (OR 3.02, P < 0.001). We found a stepwise and approximately two-fold increase in the odds ratio of postoperative transfusion and length of stay with increasing severity of anemia. Moderate-to-severe anemia was associated with increased odds of death and organ space infection. Patients with moderate-to-severe anemia should be medically optimized before ASD surgery. [ABSTRACT FROM AUTHOR]

Background: The present cross-sectional study was conducted to measure the population attributable risk (PAR) of severe anemia among children aged 6-23 months in the rural district of Kongoussi, in Burkina Faso. Methods: Sociodemographic, clinical, anthropometric, and biological data were collected from children and mothers. Results: In total, 671 children were included in the analysis, 50.4% of whom were male and 97.8% were breastfed. Only 5.8% of the children had adequate complementary feeding, 25.8% were wasted, and 23.5% stunted. Malaria affected about half (50.8%) of children; 39.3% had mild malaria and 11.5% had severe malaria. Children who were no longer breastfed were more likely to have malaria [OR = 3.98 (1.11-14.2), P = 0.022] than those who were breastfed. Fever in the last fortnight [OR = 1.49 (1.07-2.08), P = 0.019], current fever [OR = 4.30 (2.39- 7.76), P < 0.001], and presence of splenomegaly [OR = 2.68 (1.54-4.67), P < 0.001] were also positively associated with malaria. Anemia and severe anemia had a prevalence of 96.8% and 24.4%, respectively, and were associated with both mild and severe malaria. Body mass index of mothers [OR = 1.82 (1.06-3.12), P = 0.029], diarrhea in the last fortnight [OR = 1.70 (1.06-2.71), P = 0.027], stunting [OR = 1.54 (1.01-2.34), P = 0.045], and splenomegaly [OR = 2.93 (1.70-5.06), P = 0.045] were other independent factors associated with severe anemia. The PARs of severe anemia due to mild and severe malaria were 22.1% (6.1%-35.4%) and 22.0% (11.6%- 27.7%), respectively. Conclusion: Given the high frequency of anemia and severe anemia in this rural malaria-endemic area, interventions are required that consider the important contribution of malaria to anemia and aim to prevent infection. [ABSTRACT FROM AUTHOR]

Background: Pure red cell aplasia (PRCA) is a hematological disorder characterized by anemia with severe reticulocytopenia caused by a marked reduction in erythroid precursors in the bone marrow. PRCA is known to be associated with pregnancy, but thymoma-associated PRCA during pregnancy is very rare, and its successful management has not been reported.Case Presentation: A 37-year-old primiparous woman with severe anemia was referred to our center at 27 weeks' gestation. She was diagnosed with PRCA based on bone aspiration findings at 33 weeks' gestation. Magnetic resonance imaging (MRI) revealed an anterior mediastinal mass 4 cm in size suspected of being thymoma. She was therefore diagnosed with thymoma-associated PRCA during pregnancy. Surgery for thymoma was planned after delivery, since the imaging findings were suggestive of early-stage thymoma (Masaoka stage I or II). With transfusion of a total 3,360 ml of red blood cells (RBCs) during pregnancy, the patient gave birth to a baby girl weighing 2,548 g at 40 weeks' gestation. The baby showed transient congenital cutaneous candidiasis. The placental pathology revealed subamniotic inflammation with a fungal structure. Treatment with topical anti-fungal cream immediately ameliorated the baby's skin lesion. Maternal anemia did not improve after delivery; however, the thymoma did not increase in size. At five months after delivery, the mother underwent thymectomy with oral cyclosporine A. A pathological examination revealed Masaoka stage II-a thymoma. She completely had recovered from anemia at six months after surgery. Cyclosporine A treatment was discontinued three years after surgery. Remission has been sustained for four years since surgery.Conclusions: A very rare case of thymoma-associated PRCA during pregnancy was diagnosed without any subjective symptoms and was expectantly managed, resulting in a good prognosis. Although bone marrow aspiration during pregnancy is an invasive test, it is important to confirm the diagnosis. Conservative management with blood transfusion was possible for early-stage thymoma-associated PRCA during pregnancy. Active surveys, including MRI, for PRCA during pregnancy led to the detection of thymoma at an early stage and the achievement of a preferable pregnancy outcome. [ABSTRACT FROM AUTHOR]

Background: Olaparib-induced anemia is a frequently occurring complication in patients with advanced ovarian cancer, fallopian tube cancer, or primary peritoneal cancer and is associated with a marked deterioration in patients' health-related quality of life. This study aimed to clarify patient-specific risk factors for severe anemia in patients with advanced ovarian or breast cancer receiving olaparib monotherapy in a real-world setting. Methods: This multicenter, retrospective, observational study enrolled consecutively presenting patients with advanced ovarian or breast cancer who received olaparib monotherapy as maintenance or palliative treatment between April 2018 and December 2020 at three participating medical institutions in Japan. The primary endpoint was patient-associated risk factors underlying the onset of grade =3 anemia from olaparib treatment initiation to 90 days after treatment. Receiver operating characteristic curves were constructed and univariable and multivariable logistic regression analyses were performed to evaluate the association between patient-associated risk factors and grade =3 anemia. Results: Of 113 patients evaluated in this study, 32.7% (n = 37) had grade =3 anemia. Multivariable logistic regression analysis revealed that low baseline red blood cell (RBC) count (<3.3 × 106 cells/mL), low baseline hematocrit level (<35%), low baseline hemoglobin level (<11.6 g/dL), and breast cancer susceptibility (BRCA1/2) mutation were significantly associated with the onset of grade =3 anemia (adjusted odds ratio [OR], 3.39; 95% confidence interval [CI], 1.28-9.62; P = 0.017, adjusted OR, 3.63; 95% CI, 1.28-11.64; P = 0.021, adjusted OR, 3.89; 95% CI, 1.39-12.21; P = 0.014, and adjusted OR, 4.09; 95% CI, 1.55-11.67; P = 0.006, respectively). Conclusions: Our findings suggest that low baseline RBC count, low baseline hematocrit level, and low baseline hemoglobin level might be the patientassociated risk factors for severe anemia induced by olaparib monotherapy. Additionally, BRCA1/2 mutation was suggested to be a patient-related risk factor for anemia regardless of severity. Therefore, applying these patientassociated risk factors would help classify and screen patients at risk of severe anemia. [ABSTRACT FROM AUTHOR]

Langerhans cell histiocytosis (LCH) is a rare disorder predominantly affecting children and is characterized by a wide range of clinical presentations, which can make early identification of the disease difficult and result in the delay of appropriate treatment. The challenge is further compounded by the fact that diagnostic confirmation typically requires a biopsy of the bone or skin lesion, as well as immunohistochemical identification of molecular markers, which may not be readily available in all settings. This case report describes a two-year-old female who was initially misdiagnosed with infectious mononucleosis due to her non-specific presentation, highlighting the diagnostic challenges of LCH, particularly in resource-limited settings. The case highlights the importance of increasing clinical awareness of LCH and including this condition in differential diagnoses to ensure timely and appropriate management., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khundadze et al.)

Abstract Background We report a pediatric patient presenting in good general condition despite a hemoglobin value of 1,9 g/dL, which is normally regarded as life-threatening. Case presentation An African 5 years-old girl presented to our Emergency Department (ED) for worsening asthenia, within a clinical picture of good general condition. The hemoglobin value at admission was 1,9 g/dL. The subsequent diagnostic-therapeutic pathway highlighted the presence of two different causes, both well known to be responsible for chronic anemia (with slow reduction of hemoglobin values): iron deficiency anemia (IDA) due to a very low dietary intake of iron-rich foods, and homozygous sickle cell disease (HbSS). She received transfusions of packed red blood cells (overall 15 ml/kg) and subsequently intravenous iron preparations (total amount 200 mg) followed by oral iron supplements. The Hb value at discharge, 10 days after the admission, was 9.8 g/dL. Conclusions When approaching a picture of severe anemia, we suggest pediatricians take into consideration clinical conditions rather than laboratory values and to take advantage of detailed anamnestic data in order to make the diagnosis.

Anaemia is the result of a wide variety of causes that can be isolated, but more often coexist. Globally, the most significant contributor to the onset of anaemia is iron deficiency so that IDA and anaemia are often used synonymously, and the prevalence of anaemia has often been used as a proxy for IDA. It is generally assumed that 50% of the cases of anaemia are due to iron deficiency 15, but the proportion may vary among population groups and in different areas according to the local conditions. The clinical examination included resting pulse, blood pressure, nail changes, jugular venous pressure, pedal oedema, heart sounds, murmur heard, liver and spleen size and features of congestive heart failure. All patients have a complete haematological examination and peripheral smear examination. Electrocardiogram was recorded for all patients in the resting state. Eccentric hypertrophy was seen in 34 out of 100 patients, of which 24 were females and 10 were males. Eccentric hypertrophy was slightly more in females (36.9%) compared to males (28.6%). [ABSTRACT FROM AUTHOR]

The clinical presentation depends upon the rapidity of the onset of anaemia, its severity, age of the patient and capacity of the cardiovascular system to adjust to it. Anaemia affects various organs including the heart. It is one of the commonest causes of hyperdynamic state of heart at rest. This leads to increased oxygen demand to myocardium and subsequently supply-demand mismatch resulting in myocardial ischaemia or infarction. Patients with severe anemia with haemoglobin less than 7gm% will be included after applying the exclusion criteria. Detailed history will be taken for all patients, which included history of breathlessness, palpitations, chest pain, swelling of legs. The clinical examination included resting pulse, blood pressure, nail changes, jugular venous pressure, pedal oedema, heart sounds, murmur heard, liver and spleen size and features of congestive heart failure. In ECG, we noticed a prolongation of P wave duration which was seen in a total of 26(26%) patients out of 100, of which 15(23.1%) were females and 11(31.4%) were males. Prolonged P wave duration was predominantly seen in males compared to females. [ABSTRACT FROM AUTHOR]

Amsalu Molla Getahun,1 Yichalal Endayehu,2 Gebrie Dinkayehu Berhanu1 1Department of Surgery, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Regional State, Ethiopia; 2Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Regional State, EthiopiaCorrespondence: Amsalu Molla Getahun Email dramsalu@gmail.comBackground: Leeches are blood sucking hermaphroditic parasites belonged to the phylum Annelida of the class Hirudinea. Based on the location of leech infestation, the patient may present with anemia and respiratory symptoms. Even though Leech infestation is mentioned as common problem in African countries and the common cause of anemia, especially in children but it is not mentioned as a cause of severe anemia in an infant.Case Presentation: In this paper, we are reporting a 10 months old baby presented to Debre Tabor General Hospital with nasal bleeding and blood tingled vomiting of four days duration. With the diagnosis of severe anemia secondary to leech infestation, she was transfused with 360 mL of whole blood and the leech was removed from the oropharynx with McGill forceps. She was followed for 48 hours. There was no ongoing bleeding; the vital signs became stable, and then patient’s parents were advised to boil drinking water before use. Finally, the infant discharged with improvement.Conclusion and Recommendation: We concluded that leech infestation should be included as the differential diagnosis of an infant presented with nasal bleeding and blood tingled vomiting who came from rural areas.Keywords: leech, epistaxis, hematemesis, severe anemia, infant, Ethiopia

Background: Postpartum spontaneous vulvar hematoma is a rare complication of childbirth that can potentially cause maternal death if not managed properly and in a timely manner. We present the case of maternal near miss secondary to postpartum hemorrhage secondary to vulvar hematoma after home delivery in a 28-year-old para IV mother from rural Ethiopia. The case was surgically managed under spinal analgesia. The mother and her newborn were discharged on the fourth postprocedure day.Conclusion: Neglected and inappropriately managed postpartum vulvar hematoma can cause significant maternal morbidity; therefore, timely surgical exploration, ligation of bleeding vessels, and obliteration of dead space can avert severe maternal complications. [ABSTRACT FROM AUTHOR]

Amaç: Bu çalışmanın amacı derin anemisi olan hastalarda demir eksikliği anemisi sıklığını belirlemek ve demir eksikliği anemisi olan ve olmayan hastalar arasında hematolojik parametrelerdeki farklılığı incelemek ve karşılaştırmaktır.Gereç ve Yöntemler: Bu çalışmada Ocak 2012 ve Temmuz 2014 tarihleri arasında derin anemi tanısı almış olan toplam 119 hasta geriye dönük olarak incelendi. Derin anemi hastalarının demografik ve klinik özellikleri değerlendirildi. Hastalar demir eksikliği anemisi açısından değerlendirildi ve demir eksikliği anemisi olan ve olmayan hastaların klinik özellikleri ve laboratuvar bulguları karşılaştırıldı.Bulgular: Yüz on dokuz olgunun 49 (%41,2)’u erkek, 70 (%58,8)’i kız olup ortalama yaş 6,7±6,2 yıl idi. Hastalarda çeşitli eş zamanlı hastalıklar vardı. Tüm hastalarda, hemoglobin değeri 6 gr/dL’nin altında olan grup, 6 gr/dL’ye eşit ve üstünde olanlara göre anlamlı şekilde daha düşük trombosit sayısına sahipti (p=0,037). Tüm vakaların 52 (%43,7)’sinde demir eksikliği anemisi olduğu bulundu ve bunların 27 (%51,9)’si 5 ile 18 yaş arasında idi. Demir eksikliği anemisi olan hastaların ferritin düzeyi demir eksikliği anemisi olmayan hastalara göre daha düşük (p

A 22-year-old female was admitted with fever,disorientation and sudden decrease of vision in the emergency. Her evaluation showed tachycardia of 100/min and blood pressure of 90/70 with severe pallor. Her fundus examination showed findings of massive preretinal haemorrhage and Roth spots primarily restricted to the posterior pole. The ophthalmologist's findings were strongly suspicious of retinopathy associated with Haemoglobinopathies, blood tests revealed her to have a hemoglobin of 1.8 gm/dL and other reports suggestive of severe B12 and Folate deficiency. She also had systemic findings of gross anemia. After ruling out other causes of anemia she was finally diagnosed as a case of Megaloblastic anemia with decreased vision and retinopathy as a very noteworthy feature. She was treated with blood transfusions and B12 and Folate supplementation which showed a prompt response in the resolution of haemorrhages and once stable was discharged home.

Background: We report a pediatric patient presenting in good general condition despite a hemoglobin value of 1,9 g/dL, which is normally regarded as life-threatening. Case presentation: An African 5 years-old girl presented to our Emergency Department (ED) for worsening asthenia, within a clinical picture of good general condition. The hemoglobin value at admission was 1,9 g/dL. The subsequent diagnostic-therapeutic pathway highlighted the presence of two different causes, both well known to be responsible for chronic anemia (with slow reduction of hemoglobin values): iron deficiency anemia (IDA) due to a very low dietary intake of iron-rich foods, and homozygous sickle cell disease (HbSS). She received transfusions of packed red blood cells (overall 15 ml/kg) and subsequently intravenous iron preparations (total amount 200 mg) followed by oral iron supplements. The Hb value at discharge, 10 days after the admission, was 9.8 g/dL. Conclusions: When approaching a picture of severe anemia, we suggest pediatricians take into consideration clinical conditions rather than laboratory values and to take advantage of detailed anamnestic data in order to make the diagnosis. [ABSTRACT FROM AUTHOR]

Pure red cell aplasia medullary is a disorder characterized by anemia with almost complete absence of red cell precursors in the bone marrow, with leukocyte count and platelets. The Diamond-Blackfan anemia is a failure syndrome characterized by bone marrow anemia, reticulocytopenia and decreased erythroid precursors in the bone marrow. the case of an infant under 2 months of age presented no family or perinatal history major, whose mother progressive skin pallor evidence mucosa associated with hyporexia; go to health center where they perform paraclinical reporting hemoglobin 1.7 g / dL. peripheral blood smear where erythroid frankly affected with normal megakaryocytic granulocytic count shown is made; It biopsied and bone marrow aspirate concluding marrow red cell aplasia; possible anemia Diamond-Blackfan in light of other clinical findings arises. It stays with glucocorticoid treatment, however insufficient response, begins erythropoietin dose progressively increasing, despite it, warrants blood transfusions on a regular basis; compatibility studies performed with first-degree resulting positive, currently a candidate for allogeneic bone marrow transplantation. It is concluded that despite being a rare syndrome should be suspected in severe anemia where there is acute blood loss, ruling out other etiologies; also timely initiation of treatment is critical to the survival of these patients.

Background: In 2011, the World Health Organization recommended injectable artesunate as the first-line therapy for severe malaria (SM) due to its superiority in reducing mortality compared to quinine. There are limited data on long-term clinical and neurobehavioral outcomes after artemisinin use for treatment of SM.Methods: From 2008 to 2013, 502 Ugandan children with two common forms of SM, cerebral malaria and severe malarial anemia, were enrolled in a prospective observational study assessing long-term neurobehavioral and cognitive outcomes following SM. Children were evaluated a week after hospital discharge, and 6, 12, and 24 months of follow-up, and returned to hospital for any illness. In this study, we evaluated the impact of artemisinin derivatives on survival, post-discharge hospital readmission or death, and neurocognitive and behavioral outcomes over 2 years of follow-up.Results: 346 children received quinine and 156 received parenteral artemisinin therapy (artemether or artesunate). After adjustment for disease severity, artemisinin derivatives were associated with a 78% reduction in in-hospital mortality (adjusted odds ratio, 0.22; 95% CI, 0.07-0.67). Among cerebral malaria survivors, children treated with artemisinin derivatives also had reduced neurologic deficits at discharge (quinine, 41.7%; artemisinin derivatives, 23.7%, p=0.007). Over a 2-year follow-up, artemisinin derivatives as compared to quinine were associated with better adjusted scores (negative scores better) in internalizing behavior and executive function in children irrespective of the age at severe malaria episode. After adjusting for multiple comparisons, artemisinin derivatives were associated with better adjusted scores in behavior and executive function in children <6 years of age at severe malaria exposure following adjustment for child age, sex, socioeconomic status, enrichment in the home environment, and the incidence of hospitalizations over follow-up. Children receiving artesunate had the greatest reduction in mortality and benefit in behavioral outcomes and had reduced inflammation at 1-month follow-up compared to children treated with quinine.Conclusions: Treatment of severe malaria with artemisinin derivatives, particularly artesunate, results in reduced in-hospital mortality and neurologic deficits in children of all ages, reduced inflammation following recovery, and better long-term behavioral outcomes. These findings suggest artesunate has long-term beneficial effects in children surviving severe malaria. [ABSTRACT FROM AUTHOR]

Abstract Background With the development and application of endoscopic technology, most pedunculated polyps can be absolutely resected with a complete specimen by hot snare polypectomy (HSP). Brunner’s gland hamartoma (BGH) is a rare benign small bowel tumor. The majority of BGH measuring about 2 cm in diameter, rarely larger than 5 cm. Most patients are asymptomatic, some may present with gastrointestinal hemorrhage or intestinal obstruction. Symptomatic larger lesions leading to bleeding or obstruction should be excised either endoscopically or surgically. Whether it is safe and effective that removing a BGH measuring about 7 cm by HSP is not known. Case presentation Here, we reported a rare case of a proximal duodenum pedunculated mass measuring about 7 cm which was responsible for the patient’s severe anemia. we treated it as a pedunculated polyp. After being pretreated the stalk with an endoloop which was placed around the base of the mass to prevent post-polypectomy bleeding (PPB), the pedunculated BGH was removed by HSP completely. The stalk of the mass was negative. We achieved a curative resection. Conclusion It is a safe and effective for our patient to treat the pedunculated BGH measuring about 7 cm as a pedunculated polyp and remove it by HSP. And future prospective studies in larger cohorts are needed to confirm it.

Objectives: According to WHO, almost 15% pregnant women face the risk of developing complications during their gestational period. Although, the UN-mandated Millennium Development goal has prompted India to move towards achieving lower Maternal Mortality Ratio, almost 44,000 women die annually from high-risk pregnancy. Methods: The study delves into investigation with respect to the conditions of anemia, gestational diabetes mellitus and preeclampsia, which are most common and critical in such cases of high-risk pregnancy. The score-based questionnaire is used as a study instrument to assess the perception of ASHA workers towards these particular conditions. Data was recorded for all 90 ASHA workers who interact on a regular basis with pregnant women. Results: Our study showed that ASHA workers had average perception in GDM and preeclampsia, and above average perception in the condition of anemia. Knowledge gaps were observed in the referral management and practices of healthcare workers towards severely anemic patients. The healthcare workers had inadequate knowledge in the condition of GDM, its risk factors, the screening tests and threshold values to identify diabetes. Healthcare workers were not highly acquainted with the measurement of blood pressure, its standard reading, repeated measurement techniques, follow up urine tests for high blood pressure inflicted patients. Conclusions: The results suggest ASHA workers have limited knowledge in high-risk pregnancy cases and there might be a need for better training among healthcare workers and almost 90% of them had responded positively to the necessity of a portable screening device. There was observed no significant difference in the mean perception scores amongst subjects with respect to their age, education level and experience in the profession.

Vitamin B12 deficiency is a common condition that is often asymptomatic, though in severe cases may cause megaloblastic anemia and even neurologic symptoms. Occasionally, the clinical presentation can include pancytopenia and thus mimic a more concerning myelodysplastic syndrome (MDS) until corrected by B12 supplementation. In this unusual case, we present a patient with B12 deficiency who presents with severe macrocytic anemia, neutropenia, lymphocytosis, and a bone marrow morphology consistent with MDS., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mecham et al.)

This report outlines a rare case of superior vena cava (SVC) syndrome presenting with hemoptysis in a 33-year-old female Jehovah's Witness patient with a complex medical history, including systemic lupus erythematosus (SLE) and chronic hemodialysis dependency due to end-stage renal disease and a failed renal transplant. The SVC syndrome was attributed to occlusion from a right subclavian dialysis catheter. The management of this case was particularly challenging due to the patient's severe anemia and the development of a tension hemothorax following thoracentesis, compounded by her refusal of blood transfusions in adherence to her religious beliefs. A multidisciplinary approach, incorporating bloodless medical techniques such as erythropoietin and iron infusions alongside surgical interventions without blood transfusion, was successfully employed. This case sheds light on the evolving etiology of SVC syndrome and highlights the uncommon but potentially fatal occurrence of hemoptysis as a complication. It also emphasizes the importance of respecting patient values in complex medical decisions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Usman et al.)

Abstract Background Severe anaemia (SA) is a common reason for hospitalisation of children in sub-Saharan Africa but the extent to which blood transfusion is used appropriately in the management of severe anemia has hitherto remained unknown. We report on the use of blood transfusion in the management of anemic children in two hospitals in Uganda. Methods Inpatient records of children 0–5 years of age admitted to Lira and Jinja regional referral hospitals in Uganda were reviewed for children admitted on selected days between June 2016 and May 2017. Data was extracted on the results, if any, of pre-transfusion hemoglobin (Hb) level, whether or not a blood transfusion was given and inpatient outcome for all children with a diagnosis of ‘severe anemia’. Qualitative data was also collected from health workers to explain the reasons for the clinical practices at the two hospitals. Results Overall, 574/2275 (25.2%) of the children admitted in the two hospitals were assigned a diagnosis of SA. However 551 (95.9%) of children assigned a diagnosis of SA received a blood transfusion, accounting for 551/560 (98.4%) of the blood transfusions in the pediatric wards. Of the blood transfusions in SA children, only 245 (44.5%) was given appropriately per criteria (Pre-transfusion Hb ≤ 6 g/dL), while 306 (55.5%) was given inappropriately; (pre-transfusion Hb not done, n = 216, or when a transfusion is not indicated [Hb > 6.0 g/dl], n = 90). SA children transfused appropriately per Hb criteria had lower inpatient mortality compared to those transfused inappropriately, (7 (2.9%) vs. 22 (7.2%), [OR 0.4, 95% CI 0.16, 0.90]). Major issues identified by health workers as affecting use of blood transfusion included late presentation of SA children to hospital and unreliable availability of equipment for measurement of Hb. Conclusion More than half the blood transfusions given in the management of anemic children admitted to Lira and Jinja hospitals was given inappropriately either without pre-transfusion Hb testing or when not indicated. Verification of Hb level by laboratory testing and training of health workers to adhere to transfusion guidelines could result in a substantial decrease in inappropriate blood transfusion in Ugandan hospitals.

Mallory-Weiss syndrome (MWS) rarely occurs during pregnancy and can lead to massive bleed if occurring in the third trimester. Unrecognized MWS may lead to life threatening hemorrhage and shock affecting maternal and fetal well-being. We describe a rare case of MWS in a pregnant patient at 36 weeks of gestation with underlying pre-eclampsia, acute kidney injury, and hemodynamic instability. The possibility of mucosal tears should be kept in mind in the absence of an obvious source of bleeding.

A 22-year-old female was admitted with fever,disorientation and sudden decrease of vision in the emergency. Her evaluation showed tachycardia of 100/min and blood pressure of 90/70 with severe pallor. Her fundus examination showed findings of massive preretinal haemorrhage and Roth spots primarily restricted to the posterior pole. The ophthalmologist's findings were strongly suspicious of retinopathy associated with Haemoglobinopathies, blood tests revealed her to have a hemoglobin of 1.8 gm/dL and other reports suggestive of severe B12 and Folate deficiency. She also had systemic findings of gross anemia. After ruling out other causes of anemia she was finally diagnosed as a case of Megaloblastic anemia with decreased vision and retinopathy as a very noteworthy feature. She was treated with blood transfusions and B12 and Folate supplementation which showed a prompt response in the resolution of haemorrhages and once stable was discharged home. [ABSTRACT FROM AUTHOR]

Introduction: Iron deficiency anemia (IDA) is a risk factor for gastrointestinal (GI) malignancies. Little is known regarding the correlation between the depth of anemia and the risk for GI malignancy. The aim of this study was to test the hypothesis that very low hemoglobin levels pose an additional risk compared to low hemoglobin levels. Methods: Patients 40–70 years old, presenting to the ER with IDA during years 2016–2017 were retrospectively analyzed. Comparison was performed between two groups, one with a very low hemoglobin level (below 8 g/dL) and the other a low hemoglobin level (between 8–10 g/dL). Results: 1020 patients were analyzed, and 107 fulfilled the inclusion criteria. Seventy-five patients (70%) were in the very low hemoglobin group and 21 patients (19.6%) were diagnosed with a new GI malignancy. Mean age was 56, 49 (45%) were females, and 68 (63%) underwent esophagogastroduodenoscopy (EGD) or/and colonoscopy during the index hospitalization. The median hemoglobin and MCV were 7.3 G/dL, and 73 fL, respectively. New malignancies were found in 15/75 (20%) and 6/32 (19%) of patients with very low and low hemoglobin levels, respectively (p =.88). GI malignancies were more commonly found in females compared to males, 14 (29%) vs. 7 (12%), p =.032, respectively. The right colon was the most common site for malignancy. Active GI bleeding was not a risk factor for GI malignancy. Conclusions: Very low hemoglobin levels and overt GI bleeding do not pose an additional risk factor for GI malignancy, compared to low hemoglobin levels and no overt GI bleeding. [ABSTRACT FROM AUTHOR]

Objectives: To assess the correlation of different obstetrical factors with the hemoglobin level in multiparous pregnant females in Taif KSA. Anemia in pregnancy is a multifactorial phenomenon, among which obstetrical factors like parity, previous H/O abortions, inter pregnancy interval, mode of delivery etc are frequently associated. Study Design: Observational study. Setting: Outpatient department in King Faisal Hospital (KFH), Taif, Saudi Arabia. Period: 1st June 2018 and 31st August 2018. Material & Methods: Conducted in 200 pregnant women by random sampling technique. Hemoglobin value and all patient's data was noted. All data was fed to SPSS version 23.0 and statistically analyzed using chi square test for qualitative and student's t test for quantitative data. Results: The study was conducted in 200 patients that showed that there was no statistically significant association of increasing parity, inter pregnancy interval, mode of delivery (NVD or Cesarean section) & history of anemia and PPH in preceding pregnancy with the Hemoglobin level. While history of previous abortion is associated and a risk factor for anemia in pregnancy, 50% with history of 01 previous abortion had anemia while 100% of the cases with history of 02 previous abortions had moderate anemia. (Table-II). This association was observed statistically significant with p value of 0.001. Conclusion: This study concluded that anemia is a predictable as well as preventable entity. Obstetrical factors may be the contributory factors of anemia in pregnancy. Health education awareness programs, regular antenatal visits and iron supplements can be helpful to improve heath of pregnant women. [ABSTRACT FROM AUTHOR]

Background Blackwater fever (BWF), one of the complications of severe malaria, has recently re-emerged as a cause of severe anemia (SA) in African children. However, postdischarge morbidity in children with BWF has previously not been described. Methods This was a descriptive cohort study in which children, aged 0–5 years, admitted to Jinja Regional Referral Hospital with acute episodes of SA (hemoglobin ≤5.0 g/dL) were followed up for 6 months after hospitalization. Incidence of readmissions or deaths during the follow-up period was compared between SA children with BWF and those without BWF. Results A total of 279 children with SA including those with BWF (n = 92) and no BWF (n = 187) were followed for the duration of the study. Overall, 128 (45.9%) of the study participants were readmitted at least once while 22 (7.9%) died during the follow-up period. After adjusting for age, sex, nutritional status, and parasitemia, SA children with BWF had higher risk of readmissions (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.1–2.5) and a greater risk of death (HR. 3.37; 95% CI, 1.3–8.5) compared with those without BWF. Malaria and recurrence of SA were the most common reasons for readmissions. Conclusions There is a high rate of readmissions and deaths in the immediate 6 months after initial hospitalization among SA children in the Jinja hospital. SA children with BWF had increased risk of readmissions and deaths in the postdischarge period. Postdischarge malaria chemoprophylaxis should be considered for SA children living in malaria endemic areas. [ABSTRACT FROM AUTHOR]