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Background Patients with systemic sclerosis (SSc) are frequently affected by iron deficiency, particularly those with pulmonary hypertension (PH). The first data indicate the prognostic importance of hypochromic red cells (% HRC) > 2% among patients with PH. Hence, the objective of our study was to investigate the prognostic value of % HRC in SSc patients screened for PH. Methods In this retrospective, single-center cohort study, SSc patients with a screening for PH were enrolled. Clinical characteristics and laboratory and pulmonary functional parameters associated with the prognosis of SSc were analyzed using uni- and multivariable analysis. Results From 280 SSc patients screened, 171 could be included in the analysis having available data of iron metabolism (81% female, 60 ± 13 years of age, 77% limited cutaneous SSc, 65 manifest PH, and 73 pulmonary fibrosis). The patients were followed for 2.4 ± 1.8 (median 2.4) years. HRC > 2% at baseline was significantly associated with worse survival in the uni- ( p = 0.018) and multivariable ( p = 0.031) analysis independent from the presence of PH or pulmonary parenchymal manifestations. The combination of HRC > 2% and low diffusion capacity for carbon monoxide (DLCO) ≤ 65% predicted was significantly associated with survival ( p < 0.0001). Conclusion This is the first study reporting that HRC > 2% is an independent prognostic predictor of mortality and can possibly be used as a biomarker among SSc patients. The combination of HRC > 2% and DLCO ≤ 65% predicted could serve in the risk stratification of SSc patients. Larger studies are required to confirm these findings.

Keywords: thalassaemia trait, hypochromic anaemia, percentage of microcytic red blood cells, percentage of hypochromic red blood cells, microcytic to hypochromic ratio INTRODUCTION Thalassaemia is an inheritable disorder of the haemoglobins secondary to defective synthesis of a- and (3-globin chains of haemoglobin. Various red blood cell (RBC) parameters and derivative formulas have been proposed for the discrimination between thalassaemia and iron deficiency in the setting of RBC hypochromia and/or microcytosis. The study protocol was reviewed and approved by the Medical Research and Ethics Committee Malaysia (MREC), Ministry of Health Malaysia (NMRR-16-2448-33603 (IIR)), Hospital Research Review Committee HKL (HCRC.IIR-2017-01-002) and Research Ethics Committee University Malaysia (Code: FF-2017-142). Haemoglobin analysis was subsequently performed using high-performance liquid chromatography (HPLC) on Bio-Rad Variant II system (Bio-Rad Laboratories, Hercules, CA, USA) and/or capillary electrophoresis (CE) on Sebia Capillarys 2 Hex Piercing (Sebia, Paris, France).

Raised percentage hypochromic red cells (%HRC) were detected at diagnosis in 10 of 34 consecutive patients with low-risk myelodysplastic syndrome (MDS) [refractory anemia (RA) (4/26) and RA with ring sideroblasts (6/8)], all of whom had normal or increased serum ferritin and bone marrow iron stores. Elevated %HRC has persisted in all 10 cases and subsequently developed in another RA patient who later had a complete remission of MDS with normalisation of %HRC after a respiratory tract infection. A strong positive correlation was found between %HRC and erythrocyte zinc protoporphyrin levels in 11 MDS patients tested (p=0.01), suggesting that functional iron deficiency contributes to ineffective erythropoiesis in cases of MDS with raised %HRC. Five of seven patients with elevated %HRC had satisfactory haemoglobin responses to a trial of human recombinant erythropoietin without iron supplementation.

We describe a case of blood transfusion-dependent myelodysplastic syndrome (refractory anaemia), associated with macrocytosis and elevated percentage of hypochromic cells. Following an acute hospital admission with a respiratory tract infection, the patient entered a complete and sustained remission.

Background. Classical iron deficiency does not represent a particular diagnostic challenge for the clinicians. However, in several more complicated clinical conditions, classical biochemical indices such as serum iron, transferrin saturation and ferritin may not be informative enough to reflect transient iron-deficient states and functional iron deficiency. It is defined as an imbalance between iron needs of the erythroid marrow and the iron supply. Two hematological parameters, the proportions of hypochromic red cells (hypoE) and reticulocyte hemoglobin content (CHr), have major value in this setting.Conclusions. CHr and hypoE provide a useful new approach to the diagnosis of iron-deficient states. CHr is an early marker of functional iron deficiency, as reticulocytes exist in the circulation for only 1–2 days. Because erythrocytes have a lifespan about 120 days, the hypoE is able to provide information over a several month period and is a late indicator of iron-restricted erythropoiesis. With these new parameters identification of iron deficiency could be improved in some clinical conditions such as erythropoietin therapy, anemia of chronic disease, iron deficiency of early childhood and in the illicit use of erythropoietin for blood doping of competitive athletes. We have already introduced both new methods in clinical practice with cooperation between Department of hematology and Institut for Clinical Chemistry and Biochemistry.

Iron deficiency in patients with end stage renal disease (ESRD) treated by haemodialysis (HD) is difficult to diagnose. The reticulocyte hemoglobin content (CHr) and the percentage of hypochromic red cells (%hypo) are sensitive novel assays for the detection of functional iron deficiency in patients treated with erithropoietin (EPO). In our study thirty-nine chronically hemodialyzed patients were evaluated to determine the value of these two parameters in comparison to the conventional biochemical indicators of iron metabolism. There were significant correlations between CHr and transferrin saturation, CHr and weekly dosage of EPO, and also between %hypo and weekly dosage of EPO. Our data represent superior value of %hypo and CHr to the transferrin saturation and ferritin concentration in detecteng of iron deficiency in HD patients.

Dietary cadmium (Cd2+) intake is implicated in the pathogenesis of hypertension and anaemia, but there is a paucity of information on the haematological changes in hypertensive conditions. This study, therefore, aims to evaluate the effects of Cd2+ on blood pressure (BP) and haematological indices in the Sprague–Dawley rat model. Three cohorts (n = 10 each) of control and Cd2+-fed male Sprague–Dawley rats were selected. Cd2+-exposed rats received 2.5 or 5 mg/kg b.w. cadmium chloride via gavage thrice-weekly for eight weeks, while control animals received tap water. BP and flow were measured non-invasively from rat tails twice-weekly using a CODA machine, while weights were measured thrice-weekly. Haematological indices were assessed using the Cell-Dyn Emerald Haematology Analyzer. Data were reported as mean ± SEM, and statistically analyzed using One-Way Analysis of Variance. Bonferroni post hoc test was used for multiple comparisons. Cd2+-exposure induced hypertension by significantly (p < 0.05) elevating systolic, diastolic, and mean arterial BPs, pulse pressure, and heart rate (HR), and increased (p < 0.05) blood flow. Mean cell volume (MCV) and haemoglobin (MCH) were significantly (p < 0.05) reduced, and red cell distribution width (RDW) significantly (p < 0.01) increased by exposure to 5 mg/kg b.w. Cd2+. Haemoglobin concentration (MCHC), haematocrit, haemoglobin, red blood cell, platelet, mean platelet volume, and white blood cell counts were unaffected by Cd2+-exposure. Cd2+ induced hypertension, microcytosis, hypochromicity, and anisocytosis without anaemia, which may be precursor to microcytic anaemia and coronary artery disease. This study is important in Cd2+-exposed environments and warrants further investigations.

Iron Deficiency Anaemia (IDA) is the most prevalent form of anaemia, affecting 24.8% of the global population. An examination of the complete blood count (CBC) is performed to determine general health and the presence of illnesses. Accurate and timely diagnosis of IDA is essential for proper treatment, yet traditional methods can be time-consuming and costly. This study uses machine learning and computer vision techniques for the automatic identification of hypochromic microcytes from Peripheral Blood Smear (PBS) images to improve IDA diagnosis. Two approaches were implemented: first, a ResNet50 model was used to classify PBS images as Normal or IDA; second, the YOLOv7 object detection model was employed to localize hypochromic microcytes within the images. The YOLOv7 model was tested on 17 images containing 425 instances of hypochromic microcytes and demonstrated superior performance, achieving a test mean Average Precision (mAP) of 89% with faster inference times than ResNet50. By providing localized detection of hypochromic microcytes, YOLOv7 enhances diagnostic accuracy and speed compared to image-level classification. This study highlights the potential of object detection models for improving automated anaemia diagnosis, with implications for faster and more cost-effective healthcare solutions.

To identify correlates of anaemia during the first trimester of pregnancy among 366 urban South Indian pregnant women. Cross-sectional study evaluating demographic, socio-economic, anthropometric and dietary intake data on haematological outcomes. A government maternity health-care centre catering predominantly to the needs of pregnant women from the lower socio-economic strata of urban Bangalore. Pregnant women (n 366) aged ≥18 and ≤40 years, who registered for antenatal screening at ≤14 weeks of gestation. Mean age was 22·6 (sd 3·4) years, mean BMI was 20·4 (sd 3·3) kg/m2 and 236 (64·5 %) of the pregnant women were primiparous. The prevalence of anaemia (Hb <11·0 g/dl) was 30·3 % and of microcytic anaemia (anaemia with mean corpuscular volume <80 fl) 20·2 %. Mean dietary intakes of energy, Ca, Fe and folate were well below the Indian RDA. In multivariable log-binomial regression analysis, anaemia was independently associated with high dietary intakes of Ca (relative risk; 95 % CI: 1·79; 1·16, 2·76) and P (1·96; 1·31, 2·96) and high intake of meat, fish and poultry (1·94; 1·29, 2·91). Low dietary intake of multiple micronutrients, but higher intakes of nutrients that inhibit Fe absorption such as Ca and P, may help explain high rates of maternal anaemia in India.

Objectives: To develop a hitherto unavailable risk factor model for accurately predicting anemia development in cancer patients before chemotherapy (CT) administration. Methods: 2,070 nonanemic patients from the European Cancer Anaemia Survey (ECAS) with hemoglobin (Hb) ≧12 g/dl at enrollment who received their first CT during ECAS and underwent at least two CT cycles were divided randomly into split half (SH) 1 and SH2 (n = 1,035 each). The model was developed on SH1 using logistic regression to simultaneously evaluate predictive factors, and was validated using SH2 and an additional similar subpopulation of 5,901 ECAS patients. Anemia risk values were assigned to the predictive factors and the sum of the predictive factors gave the total anemia risk score; lower-, higher-, and highest-risk cutoff points of the total anemia risk score were determined. Results: Variables ultimately identified as significant predictive factors for anemia were: lower initial Hb (≤12.9 g/dl in females, and ≤13.4 g/dl in males); having lung or gynecologic cancer versus gastrointestinal (GI)/colorectal cancer; cancer at any other site versus GI/colorectal cancer; treatment with platinum CT, and female gender. Conclusion: Using this evidence-based risk model, nonanemic patients who are at the highest risk of develop ing anemia prior to receiving CT can be identified clinically, allowing appropriate anemia management to be planned.