Haematological characteristics of wild quokka (Setonix brachyurus)

Blood was collected from quokkas (Setonix brachyurus), from a mainland and an island population, and analysed as part of an assessment of animal health. Mean corpuscular haemoglobin concentration was the only analyte that was significantly different between the mainland and island populations. Quokkas from both the wild populations had lesser erythrocytic values than the captive animals. The wild quokkas also possessed three types of haemoparasites that were not recognised in the captive animals. This study illustrates the differences in the haematological characteristics between wild and captive animals.     

Acute normovolaemic anaemia prevents ethanol-induced gastric damage in rats through a blood flow related mechanism

The aim of the study was to assess whether changes in gastric mucosal blood flow induced by acute normovolaemic anaemia influence the susceptibility of the gastric mucosa to ethanol-induced damage, and the relationship of these changes with nitric oxide biosynthesis. Acute normovolaemic anaemia, promoted by exchanging 3 ml of blood by a plasma expander, induced a significant increase in gastric mucosal blood flow measured by hydrogen gas clearance, without changes in arterial blood pressure. After intragastric 60% ethanol administration, gastric blood flow was still significantly higher in anaemic than in control rats, and this was associated with a lower macroscopic and microscopic gastric damage. Following ethanol administration, anaemic rats pretreated with an inhibitor of nitric oxide biosynthesis (l-NMMA, 50 mg/kg, i.v.) had a lower gastric blood flow and a higher macroscopic gastric damage than anaemic rats without pretreatment. Anaemic rats pretreated with vasopressin also had after ethanol administration a lower gastric blood flow and a higher macroscopic gastric damage. It is concluded that acute normovolaemic anaemia protects the gastric mucosa against damage induced by intragastric ethanol. The inhibition of nitric oxide biosynthesis reverts in part this protective effect, and this seems to be related with the capability of nitric oxide to increase gastric mucosal blood flow, since vasoconstriction by a nitric oxide-independent mechanism causes a similar effect.     

Pharmacokinetics of recombinant human erythropoietin applied subcutaneously to children with chronic renal failure

The single-dose pharmacokinetics of recombinant human erythropoietin (rHuEPO) given SC was investigated in 20 patients aged 7–20 years at different stages of chronic renal failure. In a pilot study we confirmed the lower bioavailability of the drug in 2 children when given SC compared with the IV route (24% and 43%, respectively). Following administration of 4,000 units/m², rHuEPO SC effective serum erythropoietin concentrations increased from a mean baseline level (±SD) of 23±13 units/l to a mean peak concentration of 265±123 units/l, which was reached after 14.3±9.4 h, followed by a slow decline until baseline values were attained at 72 h. Mean residence time was 30±9 h and mean elimination half-time 14.3±7 h. The single-dose kinetics of SC rHuEPO in children with different degrees of renal failure are comparable to those in adult patients. Possibly, the higher efficacy of SC rHuEPO in patients with renal anaemia compared with IV rHuEPO is related to its prolonged action.     

轻度贫血食管癌患者术中输血与否的安危

目的：通过对比观察轻度贫血食管癌患者术中输血与否对围术期血流动力学及术后恢复状况的影响，以探讨病人术中不输血的安全性。方法：选择ASAI～Ⅱ级择期手术食管癌贫血病人80例，男性血红蛋白（Hb）范围在90g／L与120g／L之间，女性在90g／L与110g／L之间，随机分为输血组（T组）与非输血组（NT组）各40例，T组的Hb为（108．77．4）g／L，NT组的Hb为（109．36．4）g／L，全部采用气管插管静脉复合全麻。观察病人围术期血流动力学变化，随访术后切口愈合情况及并发症。结果：两组病人围术期血流动力学维持平稳，组间比较无明显差别（P＞0．05）；术后切口愈合良好（所有病例均为Ⅱ／甲愈合），T组有1例吻合口瘘和1例颈部切口感染，NT组无术后并发症发生。结论：术前轻度贫血食管瘤病人术中无特殊情况（如大出血）不输血是安全的。     

Decreased ferritin levels, despite iron supplementation, during erythropoietin therapy in anaemia of prematurity

Erythropoietin (rHuEPO) therapy has been shown to be beneficial in preventing and treating anaemia of prematurity and to decrease the need for blood transfusions. There is, however, only scanty data on the effect of rHuEPO therapy on iron metabolism. We studied 29 preterm infants (age 34 ± 14 days) who were randomly assigned to receive either rHuEPO 900 U kg^-1 week^-1 with 6 mg kg^-1 day^-1 of iron for 4 weeks ( n= 15) or no therapy. The following parameters were evaluated and compared between and within groups at the beginning, during and at the end of the study: Haematocrit (SI), reticulocytes (10⁹μgl^-1), serum ferritin (μg1^-1) and iron (μmol 1^-1). The results were as follows. At the baseline, erythropoietin levels were similar in both groups: 7.2 ± 5.6 versus 6.2 ± 3.2 mU ml^-1 (NS). In the treated infants the haematocrit remained stable during the study and was significantly higher than in the control group by the end of the study: 0.34 ± 0.03 versus 0.28 ± 0.05 ( p = O.001). rHuEPO therapy increased the reticulocyte count from 130 ± 70 to 430 ± 200 ( p = 0.0002). However, rHuEPO therapy depleted both serum ferritin and it-on levels from 321 ± 191 to 76 ± 58 $uMgl^-1 ( p = 0.04) and from 18 ± 5 to 13 ± 4 μmoll^-1 ( p = 0.03), respectively. We conclude that rHuEPO therapy prevented anaemia and its sequelae; however, serum ferritin and iron levels were depleted. We suggest that the effect of rHuEPO may be further increased by higher iron supplementation.     

Schistosoma mansoni in pregnancy and associations with anaemia in northwest Tanzania

Schistosomiasis among pregnant women has been inadequately investigated. In order to determine the importance of Schistosoma mansoni in this subgroup, we conducted a cross-sectional survey of 972 women in Tanzania and investigated the prevalence of Schistosoma mansoni, hookworm and malaria and their associations with anaemia. Overall, 63.5% of women were infected with S. mansoni, with prevalence highest among younger women and decreasing with increasing age. The prevalence of hookworm was 56.3%, and 16.4% of women had malaria parasitaemia. Overall, 66.4% of women were anaemic. Increased risk of anaemia was associated with heavy infection with S. mansoni but not hookworm or Plasmodium falciparum parasitaemia.     

Blood transfusion in critically injured patients: a prospective study

BACKGROUND: Despite evolving evidence that transfusion risks outweigh benefits in some patients, the critically injured continue to receive large quantities of blood. The present study evaluated patterns of red blood cell transfusions and risk factors for transfusions at various stages of admission in trauma patients. STUDY DESIGN: Prospective, observational study of transfusion practices in patients (n = 120) admitted to a single Level 1 academic trauma centre. Patients were expected to remain in the surgical intensive care unit for greater than 48 h. RESULTS: Patients had a mean age of 34.1+/- 16.0 years, a mean injury severity score (ISS) of 21.5 +/- 9.5, and were equally distributed by major injury type (48% blunt, 52% penetrating). One hundred and four patients (87%) received a total of 324 transfusions, 20 (6%) of which were given in the emergency room, 186 (57%) in the SICU, 22 (7%) post-SICU and 96 (30%) in the operating room. The mean volume of blood per patient transfused was 3144 +/- 2622 mL. One hundred and one patients received an allogeneic transfusion (mean volume 3126 +/- 2639 mL) and 10 patients received an autotransfusion (844 +/- 382 mL). The mean pre-transfusion Hb level was 9.1 +/- 1.4 g/dL. Transfusion volumes correlated with injury severity score (p = 0.011). Patients with an admission Hb < or =12 g/dL or age >55 years were at significant risk to receive increased transfusions (P < .001 and P = .035, respectively). An admission Hb < or =12 g/dL and any mention of long bone orthopedic operations or laparotomy or thoracotomy were associated with increased risk of blood transfusion during the first week of admission. Logistic regression analysis identified transfusion of >4 units of blood as a significant risk factor for SIRS. After 1 week of ICU stay, ISS > 20 and blunt injury were associated with increased risk of transfusion. CONCLUSIONS: Trauma patients are heavily transfused with allogeneic blood throughout the course of their hospital stay and transfusions are administered at relatively high pre-transfusion haemoglobin levels (mean of 9 g/dL). Transfusion of >4 units of blood is an independent risk factor for SIRS. Strategies to limit blood transfusions should be investigated in this population.     

A field survey on the health status of workers in dye-producing factories

Summary Health status of the workers in dye-producing plants were examined repeatedly in winter and in summer. The items studied cover 1) diazo-positive metabolites in urine 2) methemoglobinaemia, Heinz bodies, methemoglobin reductases and anaemia, and 3) liver function. The urinary diazo-positive metabolite level in the exposed was higher than that in the non-exposed and marked a conspicuous increase in summer as compared in winter, indicating significant intake of the aromatic nitro-amino compounds, while no significant methemoglobinaemia, Heinz bodies, anaemia nor disturbed liver function was observed in any group of the examinees. The results were discussed in connection with the dose-effect relationship, and compared with the experiences in the past.Copies should be requested to: Prof. Masayuki Ikeda, Department of Environmental Health, Tohoku University School of Medicine, Sendai 980, JapanThis work was supported by research grants from the Ministry of Labour, the Government of Japan     

Usefulness of thyrogastric immune features as predictors of pernicious anaemia that lacks intrinsic factor antibody

Introduction: The study aims to evaluate the diagnostic utility of thyrogastric immune features in the identification of intrinsic factor antibody negative (IFA ?ve) pernicious anaemia (PA) patients. Methods: Clinico‐pathological features of ‘intrinsic factor antibody positive (IFA +ve) PA’ and ‘IFA ?ve presumed PA’ Chinese patients in a single hospital (2001–2009) were studied. Coefficients of independent variables identified were used as weighted scores. The result was validated by patients (1994–2000) with Schilling test done. Results: Comparison of 127 ‘IFA +ve PA’ and 130 ‘IFA ?ve presumed PA’ patients showed four independent variables, namely (+) gastric parietal cell (GPC) antibody (OR, 2.907, 95%; CI, 2.346–3.468; P < 0.001), (+) antithyroid antibodies (OR, 3.098, 95%; CI, 2.496–3.70; P < 0.001), (+) gastric atrophy (OR, 3.827, 95%; CI, 3.041–4.64; P = 0.001), and (?) Helicobacter pylori (HP) organisms (OR, 0.134, 95%; CI, ?1.60–1.869; P = 0.023). The respective scores were 1.067, 1.131, 1.342 and ?2.012. Total scores for each patient ranged from 3.54 to ?2.012. When the cut‐off score 1.528 was applied to the validation sample (n = 75), the specificity of identifying IFA ?ve PA was 100%, sensitivity 53%, positive predictive value 100%, and negative predictive value 36%. Conclusion: Patients with two out of three features, GPC, antithyroid antibodies, gastric atrophy, but without HP organisms; or three features with HP organisms, can be predicted to have PA.     

OPTIMAL MANAGEMENT OF CHRONIC HEART FAILURE IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Chronic kidney disease and chronic heart failure are closely interlinked; an abnormality in one system adversely impacts upon the function of the other. Despite the wealth of evidence available for beneficial treatment strategies in chronic heart failure, the prognosis remains poor and optimum therapy under‐utilised. The applicability of proven therapies to patients with co‐morbidity remains a particular challenge, especially since marked renal impairment has often been an exclusion criteria in major studies. In this article we discuss the epidemiology and pathophysiology of the two conditions and then focus on the aspects of treatment most pertinent to those patients with heart failure patients and concomitant chronic kidney disease.