Diagnostic value of various laboratory parameters in acute pancreatitis]

In 427 samples of serum and urine, collected during their stay at hospital from 40 patients affected with acute pancreatitis, the sensitivity and the specifity of total amylase and lipase in serum, total amylase and pancreas isoamylase in urine, as well as the amylase-/creatinine clearance were determined. The pancreas isoamylase in serum was used as reference value. It appeared that the sensitivity of the lipase was next to that of the pancreas isoamylase in serum, even in limit ranges. Usually the lipase stayed pathological the longest and could therefore be used to identify in the best way even an easing-off pancreatitis. The diagnostic accuracy of the total amylase in serum and urine, of the pancreatic isoamylase in urine and of the amylase-/creatinine clearance was found to be obviously less reliable. The specifity of all examined tests was reduced in patients with renal insufficiency, liver disease, alcohol abuse and in patients with abdominal pains of non pancreatic origin. Concluding form our results and with regard to the expenditure of laboratory technique and to the time required by the methods of determination, we found that of all the examined parameters, the lipase was the most convenient for both emergency and routine diagnose of an acute pancreatitis.     

Prognostic value of degree and types of anaemia on clinical outcomes for hospitalised older patients

Study objectiveThis study investigated in a large sample of in-patients the impact of mild-moderate-severe anaemia on clinical outcomes such as in-hospital mortality, re-admission, and death within three months after discharge.MethodsA prospective multicentre observational study, involving older people admitted to 87 internal medicine and geriatric wards, was done in Italy between 2010 and 2012. The main clinical/laboratory data were obtained on admission and discharge. Based on haemoglobin (Hb), subjects were classified in three groups: group 1 with normal Hb, (reference group), group 2 with mildly reduced Hb (10.0–11.9 g/dL in women; 10.0–12.9 g/dL in men) and group 3 with moderately-severely reduced Hb (<10 g/dL in women and men).ResultsPatients (2678; mean age 79.2 ± 7.4 y) with anaemia (54.7%) were older, with greater functional impairment and more comorbidity. Multivariable analysis showed that mild but not moderate-severe anaemia was associated with a higher risk of hospital re-admission within three months (group 2: OR = 1.62; 95%CI 1.21–2.17). Anaemia failed to predict in-hospital mortality, while a higher risk of dying within three months was associated with the degree of Hb reduction on admission (group 2: OR = 1.82;95%CI 1.25–2.67; group 3: OR = 2.78;95%CI 1.82–4.26) and discharge (group 2: OR = 2.37;95%CI 1.48–3.93; group 3: OR = 3.70;95%CI 2.14–6.52). Normocytic and macrocytic, but not microcytic anaemia, were associated with adverse clinical outcomes.ConclusionsMild anaemia predicted hospital re-admission of older in-patients, while three-month mortality risk increased proportionally with anaemia severity. Type and severity of anaemia affected hospital re-admission and mortality, the worst prognosis being associated with normocytic and macrocytic anaemia.     

Iron deficiency and anaemia in pregnancy: modern aspects of diagnosis and therapy

The prevalence of iron-deficiency anemia in different regions of the world ranges from 12 to 43%. The increased iron requirement in pregnancy and the puerperium carry with it an increased susceptibility to iron deficiency and iron-deficiency anemia and perioperative or peripartal blood transfusion. Prevention and correction presuppose reliable laboratory parameters and a thorough understanding of the mechanisms of iron therapy. The Hb level alone is insufficient to guide management. A complete work-up (ferritin, transferrin saturation) is essential, preferably with hematological indices such as hypochromic and microcytic red cells and reticulocytes, classified by degree of maturity, in particular, before parenteral therapy is given. Since ferritin acts as both an iron-storage and acute-phase protein, it cannot be used to evaluate iron status in the presence of inflammation. A high ferritin level thus requires the presence of an inflammatory process to be eliminated before it can be taken at face value. If the C-reactive protein level is also raised, the soluble TfR concentration can be used, since it is unaffected by inflammation. Inadequate understanding of the complex chemistry of parenteral iron administration was previously responsible for serious side effects, such as toxic and allergic reactions, and even anaphylactic shock, in particular with dextran preparations. However, the current type II iron complexes that release iron to the endogenous iron-binding proteins with a half-life of about 6 hours are not only effective but carry a minimal risk of allergic accident and overload, especially after a comprehensive pretreatment work-up. Our departmental data collected over 8 years and backed by postmarketing experience in 25 countries indicate that iron sucrose complex therapy is a valid first-line option for the safe and rapid reversal of iron-deficiency anemia.     

Iron deficiency anaemia: a review of diagnosis, investigation and management

Iron deficiency anaemia (IDA) is the most common form of anaemia worldwide. In men and postmenopausal women the commonest cause of IDA is blood loss from lesions in the gastrointestinal tract, making it a common cause of referral to gastroenterologists. Causes of IDA relate either to blood loss or iron malabsorption. After confirmation with laboratory tests, gastrointestinal evaluation is almost always indicated to exclude gastrointestinal malignancy. Specific patient groups such as premenopausal women, patients with low-normal ferritin and iron-deficient patients without anaemia may need an individualized approach. A small proportion of patients have recurrent or persistent IDA despite negative standard endoscopies. These patients with obscure gastrointestinal bleeding usually require evaluation of the small bowel with capsule endoscopy or double balloon enteroscopy. Treatment should involve prompt iron replacement plus diagnostic steps directed towards correcting the underlying cause of IDA. Oral iron replacement is cheap and effective, but parenteral (intravenous) therapy may be required due to intolerance, noncompliance or treatment failure with oral therapy.     

Iron deficiency anaemia in patients with rheumatic disease receiving non-steroidal anti-inflammatory drugs: the role of upper gastrointestinal lesions.

Upper gastrointestinal lesions associated with non-steroidal anti-inflammatory drug (NSAID) treatment are commonly implicated as the cause for iron deficiency anaemia in patients with rheumatic diseases. Such patients, however, may also have other causes for iron deficiency, including blood loss from the intestine. One hundred and four patients (mean age 58 years; male 21, female 83; smokers 14) with rheumatic disease (rheumatoid 91, others 13) and absent bone marrow iron stores (mean haemoglobin 83 g/l) were examined. At endoscopy 47 of 104 (45%) had upper gastrointestinal lesions (oesophageal ulcer 4, gastric ulcer 25, gastric erosion 13, duodenal ulcer 4, gastric ulcer and duodenal ulcer 1). Endoscopic healing was assessed in 23 patients with upper gastrointestinal lesions. Eighteen of 23 (78%) lesions healed with treatment. An improvement of anaemia occurred in 10 of 18 (56%) patients with healed lesions. Twenty three of 104 (22%) patients had dyspeptic symptoms. Ten of 23 (43%) patients with dyspepsia had an upper gastrointestinal lesion as compared with 30 of 81 (37%) patients without dyspepsia. A faecal occult blood test result was available in 53 patients. Of these, 13 were positive while 40 were negative. An upper gastrointestinal lesion was present in seven of 13 (54%) patients positive for the faecal occult blood test as compared with 14 of 40 (35%) negative for the test. Thus upper gastrointestinal lesions have previously been overestimated as the cause of iron deficiency anaemia in patients receiving NSAIDs. A positive faecal occult blood test or the presence of dyspepsia is not associated with upper gastrointestinal lesions in such patients.     

Correlations between the deoxyuridine-suppressed value and some conventional haematological parameters in patients with folate or vitamin B12 deficiency.

The correlations between the deoxyuridine-suppressed value and some conventional haematological parameters (Hb concentration, red cell count, MCV, total white cell count, red cell folate level and serum vitamin B12 level) have been investigated in 40 patients with megaloblastic haemopoiesis due to folate or vitamin B12. deficiency. The only statistically significant correlations found were (a) an inverse correlation between the deoxyuridine-suppressed value and the Hb level or red cell count in both the folate- and vitamin B12-deficient groups and (b) a direct correlation between the deoxyuridine-suppressed value and MCV in the vitamin B12-deficient group. The results indicated that the deoxyuridine-suppressed value was a better index of the magnitude of the disturbance in red cell production induced by folate or vitamin B12 deficiency than either the red cell folate or serum vitamin B12 levels.     

Iron deficiency and anaemia in heart failure: understanding the FAIR‐HF trial

Treatment of anaemia in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction has traditionally focused on erythropoietin‐stimulating agents. However, recent studies have shown that treatment with intravenous (IV) iron can improve the symptoms and quality of life in patients with CHF and iron deficiency (ID), with or without anaemia. The management of ID is becoming an important therapeutic target in patients with CHF, and in this article, we will review iron metabolism in the context of anaemia and heart failure. We will also focus on the importance of diagnosing and treating ID, preferably with IV iron preparations, in patients with CHF.     

Functional erythropoietin deficiency in patients with Type 2 diabetes and anaemia.

AIMS: Anaemia is a common finding in patients with diabetic nephropathy. Impaired production of erythropoietin is thought to be the predominant cause, as a result of renal microvascular disease. This study aims to determine the prevalence of functional erythropoietin deficiency in a cross-sectional survey of patients with Type 2 diabetes. METHODS: Clinical data on 604 patients with Type 2 diabetes were obtained, including a full blood count, iron indices and detailed history of diabetic complications. Erythropoietin levels were correlated with the presence of anaemia, iron deficiency and renal dysfunction. Functional erythropoietin deficiency was defined by erythropoietin levels in the normal range despite the presence of anaemia. RESULTS: Nineteen per cent of patients (n = 112) were anaemic, among whom erythropoietin deficiency (76%) and reduced iron availability (58%) were common findings. Over 90% of patients had erythropoietin deficiency, once those with reduced iron stores or availability were excluded. Most of these patients had moderate renal impairment (60%, n = 67). However, even in the absence of renal impairment, 71% of anaemic patients (n = 32/45) had functional erythropoietin deficiency, although most had other evidence of nephropathy. In addition, two-thirds of patients with reduced iron availability were unable to increase erythropoietin above the normal range. CONCLUSIONS: These findings confirm the failure of the kidney to produce erythropoietin in response to a falling haemoglobin is a key component to anaemia in diabetes. The likelihood of functional erythropoietin deficiency as a cause of anaemia is not dependent on the severity of renal impairment or excluded in diabetic patients with reduced iron stores or availability.     

Iron deficiency anaemia and evaluation of the utility of iron deficiency indicators among healthy Nigerian children

The hemoglobin (Hb), serum iron (SI), total iron binding capacity (TIBC), transferrin saturation (TS) and serum ferritin (SF) values of 240 apparently healthy children were determined in a prospective cross-sectional study conducted in Port Harcourt, Nigeria. Standard colorimetric and enzyme immunoassay procedures were used for the estimation all variables. The mean values of all parameters in this study population were; Hb (11.2 +/- 1.83 gldl), TIBC (361.4 +/- 245.7 ugldl, log(c) SI (1.807 +/- 0.45), log(c) SF (1.51 +/- 0.47) and TS (29.3 +/- 18.5%). There was an age-dependent statistical significant difference in the Hb, TIBC and TS values (P < 0.01). Sex was not found to exert any significant influence on the parameters except TIBC. TS had the highest sensitivity and efficiency values of 48 and 95%, respectively. Positive predictive value (PPV), likelihood ratio (LR(+)) and post-test probability values were highest with SF (58%, 3.3 and 62.2%, respectively) as a diagnostic indicator. Hb values correlated positively and significantly with TS (P < 0.01), log(c) SI and log(c) SF concentrations (P < 0.05). Log(c) SF also correlated positively and significantly with Hb and TIBC (P < 0.05). The overall prevalence of iron deficiency anaemia among these children was 33.75%. We conclude that there is a high prevalence of iron deficiency anaemia among apparently healthy children under the age of five years in this part of the world and these results may justify the need for the introduction of a broad intervention programme for this highly vulnerable group. This study is also in support of the hypothesis that SF is the best test for diagnosing or excluding iron deficiency anaemia. The combination of SF, Hb and TS determinations may prove more useful in a resource-limited moderate setting.     

The prognostic value of clinical and laboratory parameters in patients with chronic lymphocytic leukemia

PURPOSE: Chronic lymphocytic leukemia (CLL) is heterogeneous in its clinical course. The aim of the present study was to identify some clinical and laboratory parameters with prognostic value in relation to survival of patients with CLL. PATIENTS AND METHODS: One hundred thirty one patients with CLL, treated in the Clinic of Hematology, Plovdiv, between 1992 and 2003 were studied. The patients' survival was analyzed by using the Kaplan-Meier method. Log-rank test was used to compare cumulative survival functions between different groups of patients. The parameters studied were: age, sex, Rai clinical stage, ECOG Performance status (PS), FAB morphological type, mediastinal lymphadenopathy, abdominal nodal mass, extranodal localization, absolute lymphocyte count, autoimmune hemolytic anemia, and response to therapy. RESULTS: The mean survival of patients was 76 months (95% Confidence Interval, 64-87). The following factors were found to carry significant prognostic value in relation to survival: Rai clinical stage, ECOG PS, mediastinal lymphadenopathy, extranodal localization, FAB morphological type and response to initial standard treatment. CONCLUSION: The prognostic factors identified in the present study can be easily applied in the clinical practice and may be used as a basis for creating mathematical prognostic models.     

非酒精性脂肪性肝炎临床检验指标与病理特点的关系

目的探讨非酒精性脂肪性肝炎（NASH）患者的临床检验指标与病理特点之间的关系,以期能为该病的临床诊断与预后提供信息。方法回顾性分析2008年5月至2011年12月本院收治的206例经肝组织学检查确诊的NASH患者的临床资料,并对ALT、AST等检验指标以及肝穿刺病理结果等相关资料进行统计学分析。不同程度的脂肪变性、炎症和肝纤维化间的检测采用独立样本的t检验或者单因素方差分析,相关性分析采用Spearman分析。结果ALT、AST、乳酸脱氢酶（LDH）对于判断肝脂肪变性、炎症及纤维化3种病理改变程度均具有统计学意义（P均〈0．05）;白细胞（WBC）、碱性磷酸酶（ALP）对于判断肝脂肪变性及纤维化程度具有统计学意义（均为P〈0．05）;平均红细胞体积（MCV）、血小板（PLT）、白蛋白（Alb）、胆碱酯酶（CHE）、γ-球蛋白电泳（γ—EP）、葡萄糖（Glu）对于判断肝脂肪变性程度具有统计学意义（P均〈0．05）;不同的肝脂肪变性程度与炎症程度、纤维化程度,不同的炎症程度与纤维化程度之间均有相关性（相关系数分别为0．261、0．561、0．353,P均〈0．05）。结论 ALT、AST、LDH对于判断肝脂肪变性、炎症及纤维化程度,WBC、ALP对于判断肝脂肪变性及纤维化程度,MCV、PLT、Alb、CHE、叫一EP、Glu对于判断肝脂肪变性程度具有统计学意义。     

Helicobacter pylori and iron deficiency anaemia in children.

BACKGROUND: Both iron deficiency anaemia and Helicobacter pylori infection are rare in developed countries. A possible connection has been suggested between these two diseases and our aim was to define the clinical picture and to study the effect of bacterial eradication in H. pylori colonized children with severe anaemia. METHODS: Eight children with iron deficiency anaemia refractory to iron supplementation were examined with gastroscopy because of suspicion of H. pylori infection. Anaemia was treated with oral ferrous sulphate. Two patients needed blood transfusions. Eradication therapy was given either with combination of colloidal bismuth subcitrate and metronidazole or with omeprazole, clarithromycin and amoxycillin. Eradication was confirmed by urea breath test 4 weeks post-treatment. RESULTS: H. pylori infection was confirmed histologically and microbiologically in all children, who also presented with chronic, active gastritis. Bacteria were successfully eradicated in 7/8 patients. Correction of haemoglobin values was observed post-treatment, iron stores still being deficient at control in 4/8 children. CONCLUSIONS: Our results suggest that H. pylori might have a role in causing iron deficiency anaemia in school-age children. Screening for H. pylori should be extended to cover those patients with other clinical manifestations than symptoms from gastrointestinal tract.     

Iron metabolism in transgenic mice with hypoplastic anaemia due to incomplete deficiency of erythropoietin

Iron overload is a serious complication of many forms of anaemia, arising in part from mechanisms associated with compensatory increases in erythropoiesis. To investigate other mechanisms by which anaemia itself may perturb iron metabolism, without the confounding effects of compensatory erythropoiesis, we studied transgenic mice with a partially disabling insertion in the erythro-poietin gene, which manifested as incomplete erythropoietin deficiency.
Mice were studied aged 7–8 weeks. Haemoglobin concentrations were 6.6 ± 0.8 g/dl in mice homozygous for the modified erythropoietin gene, 12.9 ± 2.2 g/dl in heterozygous mice and 14.1 ± 1.0 g/dl in controls. Homozygous mice showed significant hepatic iron loading (2-fold increase in liver non-haem iron, compared with heterozygous mice and normal controls, with iron staining principally in the periportal hepatocytes). Absorption studies using ⁵⁹Fe showed increased uptake from the lumen of an in vivo isolated duodenal segment in homozygous mice, although at this point in time overall transfer of radioiron to the circulation and other tissues (mucosal transfer) was not different from controls. These observations demonstrate that anaemia can lead to hepatic iron loading even in the absence of increased erythropoiesis, and are consistent with the possibility that anaemic hypoxia can enhance mucosal iron uptake by the duodenal enterocyte.