缺铁性贫血婴幼儿智能行为发育研究

目的 探讨缺铁性贫血对婴幼儿智能行为发育的影响。方法 对264名儿童进行0－36个月的生长发育纵向监测,定期对其智力发育指数（MDI）、精神运动发育指数（PDI）以及行为进行测试,根据2岁时有无缺铁性贫血分为两组：①贫血组（96名）,②非贫血组（168名）,建立数据库,用SPSS软件进行统计学分析。结果 2岁时贫血组MDI、PDI均低于对照组,且这种改变在2．5岁贫血完全被纠正时仍未安全消除;2岁缺铁性贫血患儿血红蛋白水平与其MDI和PDI分值呈正相关;缺铁性贫血组儿童2－3岁期间行为问题发生率明显高于对照组,突出表现在社交退缩和躯体诉述两个行为因子上。结论 缺铁性贫血对婴幼儿智能行为发育均产生重要影响,鉴于对智能发育的不利影响是长期的,积极防治婴幼儿期缺铁性贫血对于保证儿童正常生长发育具有重要意义。     

94例缺铁性贫血患者的病因分析

目的 :通过对确诊为缺铁性贫血的病例进行病因学分析 ,探讨多病变和恶性肿瘤在缺铁性贫血发病中的重要性。方法 :确诊为缺铁性贫血 (IDA)的患者 94例 ,行大便虫卵检查 ,胃镜、结肠镜或钡餐、钡灌肠 ,腹腔B超 ,女性加做妇科检查及盆腔B超检查 ,找出IDA病因。将 94例患者按病因分类分为单一病因组和多病变组 ,用t检验对两组的Hb、SF值进行比较 ;再分为良性病变组和恶性肿瘤组 ,两组间的Hb、SF值也以t检验进行比较。结果 :94例IDA患者的病因中 ,由单一病因致病者 75 .5 % ,以消化性溃疡 (2 7.7% )和慢性胃炎 (17.0 % )为主 ,月经失血过多(2 0 .2 % )仍是女性患者的主要病因 ;多病变致病者 2 4.5 %。良性病变占 86 .2 % ,消化道恶性肿瘤占 13.8%。各组间Hb值均无显著差别 (P >0 .0 5 ) ,但恶性肿瘤组SF值明显高于良性病变组 (P <0 .0 1)。结论 :良性消化道出血性病变仍是导致IDA的主要原因 ,其次为女性月经过多。但多病变导致缺铁 ,尤其是上下消化道多个失血灶同时存在者 (14.9% )也不少见。恶性肿瘤在IDA病因中有增多趋势。恶性肿瘤致IDA的患者SF较高。     

强氧酸性离子水毒性试验研究

目的 了解新型消毒剂强氧酸性离子水的毒性。方法 采用一次性限量灌胃法测定急性经口ＬＤ５０;采用剂量递增蓄积系数法测定蓄积毒性;采用取样前３０小时、６小时两次给予受试物法测定其对小鼠骨髓嗜多染红细胞微核形成的影响;用斑贴法测定其对动物的皮肤刺激强度;用棉条浸入法测定其对大鼠阴道粘膜的刺激强度。结果急性经口ＬＤ５０大于２１５００ｍｇ／ｋｇ·ｂｗ,属实际无毒物,蓄积试验属弱蓄积性,对小鼠骨髓微核细胞未见损伤作用,对家兔皮肤和大鼠阴道粘膜无刺激。结论 强氧酸性离子水是一种安全的消毒剂。     

转铁蛋白受体和铁蛋白在缺铁性贫血诊断中的意义

目的 :探讨可溶性转铁蛋白受体 (sTfR)、血清中铁蛋白 (SF)在缺铁性贫血诊断中的意义。方法 :分别应用免疫比浊法和化学发光法测定缺铁性贫血、隐性缺铁患者和正常对照组的转铁蛋白受体和铁蛋白。结果 :缺铁性贫血组sTfR的值为 7.2 3± 4 .5 2mg/L ,明显高于隐性缺铁组 (2 4 3± 0 77mg/L ,P <0 0 1)和正常对照组 (1 34± 0 35mg/L ,P <0 0 1)。缺铁性贫血组和隐性缺铁组的SF分别为 :4 3± 1 8μg/L ,7 2± 3 7μg/L ,两组均明显低于对照组 (46 5± 18 2 μg/L)。结论 :sTfR是诊断缺铁性贫血的较敏感的指标 ,SF是诊断隐性缺铁可靠指标。联合检测sTfR和SF ,尤其是计算sTfR/SF对于早期诊断缺铁性贫血具有重要意义。     

贫血患者血清铁铁蛋白细胞内外铁检测结果分析

目的探讨各类贫血患者血清铁、铁蛋白和骨髓细胞内外铁含量多或寡与贫血症的相互关系.方法应用比色法、放射免疫法和普鲁士兰反应法检测186例各种贫血患者血清铁、铁蛋白浓度和细胞内外铁粒、铁小珠的含量.结果急、慢性白血病贫血、再生障碍性贫血、铁粒幼红细胞性贫血、溶血性贫血、巨幼红细胞性贫血患者血清铁浓度升高;肾性贫血、肝性贫血、缺铁性贫血、肿瘤性贫血、骨髓增生异常综合症(MDS-RA)患者血清铁下降;铁蛋白增高主要见于急、慢性白血病贫血和铁粒幼红细胞性贫血、肿瘤性贫血及骨髓增生异常综合症等;细胞内外铁颗粒减少和外铁消失主要见于缺铁性贫血和肾性贫血.结论检测血清铁、铁蛋白和细胞内外铁能灵敏地反映机体铁的贮存和利用水平;恶性肿瘤或其它细胞快速增殖时,细胞合成铁蛋白的能力较强.     

Iron Deficiency Anemia is Associated with Increased Early Postoperative Surgical and Medical Complications Following Total Hip Arthroplasty

BackgroundIron deficiency anemia (IDA) is a medical comorbidity commonly diagnosed in those undergoing primary total hip arthroplasty (THA). The authors sought to evaluate IDA as a risk factor for early postoperative complications following discharge and describe the hospital resource utilization of this patient population.MethodsPatients with a diagnosis of IDA who underwent THA from 2005 to 2014 were identified in a national insurance database. The rates of postoperative medical complications and surgery-related complications, as well as hospital readmission, emergency department visits, and death were calculated. Additionally, 90-day and day of surgery cost and length of stay were calculated. IDA patients were then compared to a 4:1 matched control population without IDA using a logistic regression analysis to control for confounding factors.ResultsIn total, 98,681 patients with a preoperative diagnosis of IDA who underwent THA were identified and compared to 386,724 controls. IDA was associated with increased risk of 30-day emergency department visits (odds ratio [OR] 1.35, P < .001) and 30-day readmission (OR 1.49, P < .001). IDA was also associated with an increased 90-day medical complication rate (cerebrovascular accident OR 1.11, P = .003; urinary tract infection OR 1.14, P < .001; acute renal failure OR 1.24, P < .001; transfusion OR 1.40, P < .001), as well as 1-year periprosthetic joint infection (OR 1.27, P < .001), revision (OR 1.22, P < .001), dislocation (OR 1.25, P < .001), and fracture (OR 1.43, P < .001). Patients with IDA accrued higher hospital charges ($27,658.27 vs $16,709.18, P < .001) and lower hospital reimbursement ($5509.90 vs $3605.59, P < .001).ConclusionPatients with preoperative IDA undergoing THA are at greater risk of experiencing early postoperative complications and have greater utilization of hospital resources.     

Iron,coronary artery calcification,and mortality in patients undergoing hemodialysis

ObjectiveA high coronary artery calcification score (CACS) may be associated with high mortality in patients undergoing hemodialysis (HD). Recently, effects of iron on vascular smooth muscle cell calcification have been described. We aimed to investigate the relationships between iron, CACS, and mortality in HD patients.MethodsWe studied 173 consecutive patients who were undergoing maintenance HD. Laboratory data and Agatston’s CACS were obtained at baseline for two groups of patients: those with CACS ≥400 (n = 109) and those with CACS <400 (n = 64). Logistic regression analyses for CACS ≥400 and Cox proportional hazard analyses for mortality were conducted.ResultsThe median (interquartile range) age and duration of dialysis of the participants were 67 (60–75) years and 73 (37–138) months, respectively. Serum iron (Fe) and transferrin saturation (TSAT) levels were significantly lower in participants with CACS ≥400 than in those with CACS <400, although the serum ferritin concentration did not differ between the groups. TSAT ≥21% was significantly associated with CACS ≥400 (odds ratio 0.46, p<0.05). TSAT ≥17%, Fe ≥63 µg/dL, and ferritin ≥200 ng/mL appear to protect against 5-year all-cause mortality in HD patients, independent of conventional risk factors of all-cause mortality (p < 0.05).ConclusionWe have identified associations between iron, CACS, and mortality in HD patients. Lower TSAT was found to be an independent predictor of CACS ≥400, and iron deficiency (low TSAT, iron, or ferritin) was a significant predictor of 5-year all-cause mortality in HD patients.     

Observational study of pre-operative intravenous iron given to anaemic patients before elective cardiac surgery

Cardiac surgical patients with anaemia experience increased morbidity and mortality. Iron deficiency is the most common cause of pre-operative anaemia in this group. We designed and implemented the Cardiff Pathway, a pre-assessment and treatment pathway to identify cardiac surgical patients with anaemia and iron deficiency. Patients identified with anaemia and/or iron deficiency (Hb < 130 g.l^-1 and ferritin < 100 μg.l^-1) were offered intravenous iron infusion 20 mg.kg^-1 pre-operatively. Treatment success was defined as Hb ≥ 130g.l^-1 on the day of surgery. We analysed data from 447 patients: 300 (67%) were not anaemic; 75 (17%) were anaemic and treated with intravenous iron; and 72 (16%) were anaemic and not treated. Haemoglobin concentration increased in successfully treated anaemic patients by a mean (95%CI) of 17 (13–21) g.l^-1 and they received a median (IQR [range]) of 0 (0–2 [0–15]) units of blood peri-operatively. Transfusion was avoided in 54% of the successfully treated anaemic patients, which was significantly more than the unsuccessfully treated anaemic (22%, p = 0.005) and untreated anaemic (28%, p = 0.018) patients and similar to non-anaemic patients who received a median (IQR [range] of 0 (0–1 [0–16])) units of blood and, 63% avoided transfusion). Mean (95%CI) Hb fell between pre-assessment and surgery in the untreated anaemic (-2 (0 to -4) g.l^-1) and non-anaemic groups (-2 (-1 to -3) g.l^-1). Twenty-one (7%) of the non-anaemic group became newly anaemic waiting for surgery. The Cardiff Pathway reliably identified patients with anaemia and iron deficiency. Anaemic patients who had their Hb restored to normal after treatment required less blood peri-operatively and over half of them required no transfusion at all.