Thrombocytopenia secondary to iron deficiency anemia responding to iron therapy

A broad spectrum of diseases can cause anemia and thrombocytopenia. Some of these diseases are a hematological emergency; others are benign diseases, so early and accurate diagnosis is crucial in managing such patients. Usually, IDA is associated with thrombocytosis or normal platelets; however, in rare cases, IDA can be associated with thrombocytopenia; even though, thrombocytopenia that occurs with IDA responds to iron therapy. Iron therapy rarely causes transient thrombocytopenia per se. We are reporting an African female patient who is found to have thrombocytopenia secondary to iron deficiency anemia (IDA), and she responded to iron replacement therapy initially with a transient drop in platelets, followed by a rapid rise in platelets till platelets reached the normal level.     

Calcium transport across the colon ascendens and the influence of 1,25-dihydroxyvitamin D3 and dexamethasone

Abstract. Concentration dependence of unidirectional calcium fluxes across the rat colon ascendens were measured in a modified Ussing chamber. Both the mucosa (m) to serosa (s) and the s to m calcium flux exhibited saturation kinetics. The maximum transport rates and the affinity to the transporter of calcium was higher in the m to s direction than that from s to m, resulting in a remarkable net calcium absorption. The results obtained from measurements of unidirectional calcium fluxes in dependence on clamped transepithelial potentials showed that: (i) calcium transport in both direction had a voltage-independent component; (ii) the voltage-independent, i.e. non diffusive fraction of the m to s calcium flux was 3·2 times greater than that in the opposite direction; (iii) the voltage dependent, i.e. diffusional fraction of the m to s calcium flux, was about two times greater than the voltage-dependent fraction of the calcium flux in the s to m direction; and (iv) in the m to s direction 62%, and in the s to m direction 73%, of the total unidirectional flux was voltage-dependent. Dexamethasone, known to enhance sodium and water absorption in the colon, had no significant influence on net calcium absorption but increased the unidirectional calcium fluxes in both directions. The increase in unidirectional calcium fluxes parallel to that of the extracellular marker mannitol suggests that dexamethasone has no influence on the transcellular calcium transport but increases the calcium flux along the paracellular way. Amiloride had no influence on the dexamethasone-induced changes of the epithelial electrical parameters as distinguished from the colon descendens. The increase in calcium and mannitol fluxes after dexamethasone treatment was also unaffected by amiloride. 1,25(OH)₂D₃ had no influence on the kinetics of unidirectional calcium fluxes as distinguished from the colon descendens. The electrical parameters of the tissue and unidirectional mannitol fluxes were also unaffected by 1,25(OH)₂D₃. The mode of calcium transport found in the colon ascendens exhibits characteristics distinct from the transport properties reported for the colon descendens. The heterogeneity of both parts, with respect to the calcium transport, suggests that both colonic segments might have different functions in the final modulation of calcium balance by the intestine.     

Simultaneous double obstruction of the proximal colon: A case report

A rare case of simultaneous obstructions of the proximal colon secondary to an obstructing carcinoma of the transverse colon and an ascending colon volvulus at the hepatic flexure is presented. Their probable interrelationship and resulting radiographic features are discussed.     

Ion transport in proximal colon of the rat. Sodium depletion stimulates neutral sodium chloride absorption.

The model of sodium and chloride transport proposed for the colon is based on studies performed in the distal segment and tacitly assumes that ion transport is similar throughout the colon. In rat distal colon, neutral sodium-chloride absorption accounts for the major fraction of overall sodium absorption and aldosterone stimulates electrogenic, amiloride-sensitive sodium absorption. Since we have demonstrated qualitative differences in potassium transport in proximal and distal segments of rat colon, unidirectional 22Na and 36Cl fluxes were performed under short-circuit conditions across isolated proximal colon of control and sodium-depleted rats with secondary hyperaldosteronism. In the control group, net sodium absorption (JNanet) (7.4 +/- 0.5 mu eq/h . cm2) was greater than Isc (1.4 +/- 0.1 mu eq/h . cm2), and JClnet was 0 in Ringer solution. Residual flux (JR) was -5.2 +/- 0.5 mu eq/h . cm2 consistent with hydrogen ion secretion suggesting that neutral sodium absorption may represent sodium-hydrogen exchange. 1 mM mucosal amiloride, which inhibits sodium-hydrogen exchange in other epithelia, produced comparable decreases in JNanet and JR (4.1 +/- 0.6 and 3.2 +/- 0.6 mu eq/h . cm2, respectively) without a parallel fall in Isc. Sodium depletion stimulated JNanet, JClnet, and Isc by 7.0 +/- 1.4, 6.3 +/- 1.9, and 0.8 +/- 0.2 mu eq/h . cm2, respectively, and 1 mM amiloride markedly inhibited JNanet and JClnet by 6.0 +/- 1.1 and 4.0 +/- 1.6 mu eq/h . cm2, respectively, with only a minimal reduction in Isc. Conclusions: the predominant neutral sodium-absorptive mechanism in proximal colon is sodium-hydrogen exchange. Sodium depletion stimulates electroneutral chloride-dependent sodium absorption (most likely as a result of increasing sodium-hydrogen and chloride-bicarbonate exchanges), not electrogenic chloride-independent sodium transport. The model of ion transport in the proximal colon is distinct from that of the distal colon.     

CHr在缺铁性贫血中的诊断意义

目的探讨CHr在缺铁性贫血中的诊断价值。方法选取病例120例,分别建立IDA患者组和非IDA患者组,在体检人群中选出正常对照30例,分别比较正常对照组、IDA贫血组和非IDA贫血组CHr、CH、MCV、SI等参数的均值,并按贫血诊断标准比较这四个参数的灵敏度和特异度。结果IDA贫血组与健康组和非IDA组相比均有统计学意义（P〈0．05）;非IDA组与健康组相比差别无统计学意义（P〉0．5）;四个参数中CHr的灵敏度和特异度均高于其他三个参数。结论CHr能够简便、快速、特异地诊断缺铁性贫血。     

健脾生血颗粒联合多糖铁复合物胶囊治疗妊娠期缺铁性贫血的效果

目的 分析健脾生血颗粒联合多糖铁复合物胶囊治疗妊娠期缺铁性贫血(IDA)的效果.方法 选取2018年11月至2020年3月在我院产科定期产检的IDA孕妇90例,将其随机分为A组(45例,多糖铁复合物胶囊)和B组(45例,健脾生血颗粒联合多糖铁复合物胶囊).比较两组的治疗效果.结果 治疗后,B组的Hb水平、MCV、MCH...     

多糖铁复合物胶囊和硫酸亚铁片治疗缺铁性贫血的疗效比较

目的：观察多糖铁复合物胶囊和硫酸亚铁片治疗缺铁性贫血的临床疗效。方法：选择2012年10月-2013年10月确诊的缺铁性贫血患者190例,随机分为两组,各95例。对照组口服硫酸亚铁片,每次2片,每日3次,治疗组口服多糖铁复合物胶囊,每次2粒,每日1次。治疗14周,观察两组患者治疗前后血常规各项指标变化情况以及临床疗效。结果：两组患者治疗后血常规红细胞指标均有所改善,治疗组与对照组比较差异有统计学意义（ P 〈0.05）,白细胞和血小板指标变化比较差异无统计学意义（P〉0.05）。治疗组治疗后和对照组治疗后总有效率比较,差异有统计学意义（P 〈0.05）。结论：口服多糖铁复合物胶囊改善缺铁性贫血的效果优于硫酸亚铁片,是一种安全有效的补铁制剂。     

股骨近端锁定钢板与PFNA治疗股骨近端骨折的临床效果比较

目的 比较股骨近端锁定钢板与股骨近端防旋髓内钉(PFNA)治疗股骨近端骨折的临床效果.方法 选取2017年1月至2021年1月收治的78例股骨近端骨折患者作为研究对象,遵循随机原则将其分为对照组(n=39)与研究组(n=39).对照组开展股骨近端锁定钢板治疗,研究组开展PFNA治疗.比较两组的临床疗效、手术情况、术后康...     

基层托幼机构儿童贫血及铁缺乏症现状调查

目的 调查基层托幼机构儿童铁缺乏症的现状,以便早发现、早治疗.方法 对基层托幼机构健康体检的2 258例儿童采用问卷形式调查,并进行了血常规检查,以调查贫血患者情况;并随机抽取372例进行血清铁(Fe)检测、血清铁蛋白(SF)检测、可溶性转铁蛋白受体(sTFR)指标检测调查铁缺乏症的现状.结果 基层托幼机构2 258例儿童贫血发生率7.7%,铁缺乏症患病率是22.3%,其中ID占10.8%,IDE占8.8%,IDA占2.7%,亚临床铁缺乏SID(ID+IDE)占缺铁总人数的87.9%.结论 基层托幼机构儿童贫血发生率不高,但是铁缺乏症较为普遍,特别是亚临床铁缺乏(SID)检出率很高,采取早期鉴定、干预,加强防治工作及对托幼机构膳食指导有重要意义.     

静脉应用蔗糖铁纠正功能性缺铁对血液透析患者贫血的作用

目的通过比较静脉铁剂蔗糖铁注射液和口服铁剂琥珀酸亚铁分别联合应用基因重组人红细胞生成素(EPO),治疗伴有功能性缺铁的维持血液透析患者贫血的疗效,探讨对功能性缺铁的补铁途径和方法.方法采用前瞻性、随机、对照的研究.25例维持血液透析、存在功能性缺铁和贫血的患者分为静脉组和口服组;①静脉组13例,100mg蔗糖铁注射液稀释于100ml生理盐水,透析中静脉滴注,每周一次,共10次,总补铁量1 000mg;②口服组12例,琥珀酸亚铁200mg每日3次,共10周.两组患者均联合EPO治疗,剂量为100～180U/kg/week,均皮下注射.每2周检测1次患者的血红蛋白(Hb)、红细胞压积(Hct)和网织红细胞(Ret);每4周查1次网织红细胞血红蛋白含量(reticulocyte hemoglobin content,CHr)、低色素红细胞百分比(percentage of hypochromic red blood cells,%HRC)、血清铁蛋白(serumferritin,SF)和转铁蛋白饱和度(transferritin saturation,TS);治疗前和治疗后分别取血查叶酸、VitaminB12、CRP、ALT、AST、Tbil、Alb、BUN和Cr等.结果治疗前静脉组与口服组之间在男、女性别比例、年龄、体重和接受治疗前维持透析时间及Hb、Hct、Ret、CHr、%HRC、SF和TS等方面均无显著性差异别.静脉组Hb、Hct、CHr、SF和TS于治疗4周后均明显升高,%HRC明显降低;口服组Hb和Hct于治疗6周后明显升高.治疗结束时,静脉组Hb由治疗前的(78.5±5.9)g/L升至(104.4±8.1)g/L(P＜0.001),Hct由23.6%±1.7%升至31.4%±2.5%(P＜0.001),CHr由(27.1±1.2)pg升至(29.9±1.5)pg(P＜0.001),SF由(211±71)μgL升至(283±62)μg/L(P＜0.01);TS由13.3%±3.4%升至20.0%±2.9%(P＜0.01),%HRC从5.7%±3.1%降至2.6%±1.2%(P＜0.001);口服组Hb由(79.2±6.0)升至(96.3±5.5)g/L(P＜0.001);Hct由23.7%±1.8%升至29.1%±1.6%(P＜0.001).治疗结束时,静脉组Hb、Hct、CHr、SF和TS均明显高于口服组[Hb:(104.4±8.1)g/L vs(96.3±5.5)g/L,(P＜0.01);Hct:31.4%±2.5%vs 29.1%±1.6%,(P＜0.05);CHr:(29.9±1.5)pg vs(27.7±1.6)pg,(P＜0.01);SF:(283±62)μg/L vs(221±57)μg/L,(P＜0.05);TS:20.0%±2.9%vs 14.4%±3.5%,P＜0.01];%HRC明显低于口服组2.6%±1.2%vs 4.4%±1.6%,(P＜0.01).两组平均EPO剂量无显著性差异[静脉组:(141±11)U/kg/week vs口服组:(136±16)U/kg/week,P＞0.05].治疗后两组患者血清BUN、Cr、ALT、AST、Tbil、Mb、CRP、叶酸和VitaminB12等均无明显变化.结论血液透析患者,即使铁储备正常,若存在功能性缺铁,仍需静脉补铁.与口服铁剂琥珀酸亚铁比较,蔗糖铁注射液可更好地纠正透析患者的功能性缺铁,增加铁储备,改善EPO的疗效.     

Serum ferritin thresholds for the diagnosis of iron deficiency in pregnancy: a systematic review

The aim of this review was to understand the landscape of serum ferritin in diagnosing iron deficiency in the aetiology of anaemia in pregnancy. Iron deficiency in pregnancy is a major public health problem leading to the development of anaemia. Reducing the global prevalence of anaemia in women of reproductive age is a 2025 global nutrition target. Bone marrow aspiration is the gold standard test for iron deficiency but requires an invasive procedure; therefore, serum ferritin is the most clinically useful test. We undertook a systematic search of electronic databases and trial registers from inception to January 2016. Studies of iron or micronutrient supplementation in pregnancy with pre‐defined serum ferritin thresholds were included. Two independent reviewers selected studies, extracted data and assessed quality. There were 76 relevant studies mainly of observational study design (57%). The most commonly used thresholds of serum ferritin for the diagnosis of iron deficiency were <12 and <15 ng mL^?1 (68%). Most primary studies provided no justification for the choice of serum ferritin threshold used, but 25 studies (33%) used thresholds defined by expert consensus in a guideline development process. There were five studies (7%) using a serum ferritin threshold defining iron deficiency derived from primary studies of bone marrow aspiration. Unified international thresholds of iron deficiency for women throughout pregnancy are required for accurate assessments of the global disease burden and for evaluating effectiveness of interventions addressing this problem.     

维生素AD联合铁剂治疗婴幼儿缺铁性贫血的效果

目的:观察维生素AD滴剂联合蛋白琥珀酸铁口服液治疗婴幼儿缺铁性贫血的临床效果。方法:选取安徽省庐江县人民医院儿童保健门诊缺铁性贫血患儿102例,性别不限,采用随机数字表法分为观察组(n=52)和对照组(n=50)。观察组治疗采用蛋白琥珀酸铁口服液联合维生素AD滴剂口服,对照组治疗仅采用蛋白琥珀酸铁口服液口服。治疗前分析缺铁性贫血患儿维生素A和25-羟维生素D缺乏情况,于治疗1个月后对2组治疗效果进行比较并对贫血相关指标进行分析。结果:治疗前两组缺铁性贫血患儿维生素A和25-羟维生素D缺乏严重。治疗后,观察组的显效率为61.54%,明显高于对照组的44%(P<0.05);总有效率为94.23%,也明显高于对照组的84%(P<0.05);观察组血红蛋白、血清铁和血清铁蛋白较对照组明显改善(P<0.05)。结论:维生素AD滴剂联合蛋白琥珀酸铁口服液用于婴幼儿缺铁性贫血治疗时可有效改善患儿相关的贫血指标,显著提高临床治疗效果。     

献血者铁缺乏:现状与管理

随着全球无偿献血的发展,人们对献血者铁缺乏风险的认识也在不断提高.目前已知献血的唯一明显缺点就是潜在的铁缺乏风险.因此,预防献血者铁缺乏的发生十分必要.近20年内,在输血医学伦理规范的大背景下,遵循对献血者的尊重和无伤害原则,促成了基于国家和地区层面针对献血者铁代谢管理实施干预的发展.近10年美国血库联合会(AABB)...     

上海市某社区婴幼儿缺铁性贫血情况调查及影响因素分析

目的:调查上海市浦东新区塘桥社区婴幼儿缺铁性贫血(iron deficiency anemia,IDA)的流行病学特征,为婴幼儿IDA的防治工作提供依据。方法:回顾性调查2010年1月至2015年12月出生于上海市浦东新区塘桥街道,且在塘桥社区卫生服务中心儿保门诊进行系统健康检查的户籍儿童的健康档案,分析IDA患病情况及相关危险因素。结果:共调查婴幼儿1 026例。婴幼儿IDA患病率为14.62%(150例),男女性IDA患病率差异无统计学意义;0~6个月龄、6~12个月龄及12~24个月龄IDA患儿分别占IDA患儿总数的7.33%、74.00%和18.67%。IDA婴幼儿断母乳时间晚于非IDA婴幼儿(P0.01),开始添加辅食时间晚于非IDA婴幼儿(P0.01)。早产、4个月龄内母乳喂养、断母乳时间≥4个月龄以及开始添加辅食时间大于6个月龄的婴幼儿IDA患病率较高(P0.01)。Logistic多因素回归分析发现,头胎(OR=0.414)、4个月龄内混合喂养(OR=0.209)是预防儿童发生IDA的保护因素;早产(OR=3.781)、断母乳时间晚(OR=1.102)是儿童发生IDA的危险因素(P0.05)。结论:上海市塘桥社区婴幼儿IDA患病率较高,建议加强社区孕产妇围生期保健宣教,减少早产发生;强调对特定群体(早产儿、二胎或二胎以上、6~12个月龄)婴幼儿进行合理喂养,及时断奶并添加辅食,作为预防IDA发生的措施。     

急性ST段抬高型心肌梗死患者血清铁水平降低与院内急性心力衰竭的相关性

目的观察急性ST段抬高型心肌梗死(STEMI)患者入院时血清铁(SF)水平与急性心力衰竭(AHF)发生率的相关性。方法对203例首次住院的急性STEMI患者资料进行回顾性分析,按住院期间是否发生AHF将患者分为AHF组和无AHF(NAHF)组,比较两组SF降低(8.95μmol/L)的百分率;按SF水平的四分位数分为Q1(6.1μmol/L)、Q2(6.1~9.2μmol/L)、Q3(9.3~12.8μmol/L)和Q4(12.8μmol/L)组,比较不同SF水平组的院内AHF发生率;分析SF水平与Hb、B型钠尿肽(BNP)、心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、C反应蛋白(CRP)水平和左室射血分数(LVEF)等参数的相关性。结果 AHF组SF降低的发生率比NAHF组高(55.6%vs 33.8%,P0.05);Q1~Q4组院内AHF的发病率分别是78.4%、76.0%、56.9%和54.9%(P0.05);在SF较低的组,前壁心肌梗死的发生率较高(P0.05),CRP水平较高(P0.05),LVEF较低(P0.05)。相关分析表明SF水平与CRP呈负相关(r=-0.571,P0.05),与LVEF呈正相关(r=0.267,P0.05),与BNP和住院天数呈负相关(r=-0.286、-0.233,P0.05)。结论急性STEMI患者入院SF水平越低,院内心力衰竭发病率越高。