Pre-optimization of the anaemic patient

Preoperative anaemia is common. Its prevalence varies according to the population studied and the definition of what constitutes anaemia. Where the widely accepted definition of the World Health Organization is used (haemoglobin concentration <130 g/l in men or <120 g/l in women), between 20% and 60% of surgical patients are found to be anaemic. Anaemia is well known to contribute to increased peri-operative risk. In contrast to the other well-known risk determinants (e.g. age, magnitude of surgery, the presence or absence of a cancer diagnosis, renal failure etc.), anaemia is potentially modifiable. This article will give an overview of the approach to a patient found to be anaemic before surgery.     

血清可溶性转铁蛋白受体在铁营养状况评价中的价值

目的了解青春期女性血清可溶性转铁蛋白受体（s．TfR）水平及其在铁营养状况评价中的价值。方法1．选择目标人群中的健康者为研究对象,确定该人群s—TfR的参考值范围。2．采用传统的评价指标将目标人群分为铁营养状况正常组,隐性缺铁（rlD）组和缺铁性贫血（IDA）组,比较3组的血清铁蛋白（SF）、s—TIR、s—TfR／lgSF和血红蛋白（Hb）水平。3．用两种不同的方法诊断IDA,分别比较IDA组与非IDA贫血（non-IDA）组及正常组与non-IDA组SF、s—TfR、s—TfR／lgSF、Hb水平。结果1．该人群血清s—TfR参考值范围为1．616～24．516μmol／L。2．按照传统诊断方法,不同铁营养状况组的s—TfR、s—TfR／lgSF、Hb值差异有统计学意义（P〈0．05）,SF值在rlD和IDA两组间差异无统计学意义。3．用SF＋Hb法诊断IDA,IDA组和non．IDA组的s—TfR水平差异无统计学意义,non—IDA组的s-TfR值已超出该人群参考值的上限,是正常均值的2．36倍;non—IDA组的s．TfR,s-TfR／lgSF值均高于正常组;用SF＋Hb＋s-TfR法诊断IDA,IDA组和non—IDA组比较,SF、s-TfR、s—TfR／IgSF值差异均有统计学意义（P〈0．05）;除Hb外,non—IDA组与正常组的各项铁生化指标差异均无统计学意义。结论s．TfR能很好的反映机体铁营养状况,在评价人群（尤其存在感染情况的人群）的铁营养状况时,联合应用s—TfR和SF两项指标,可能会有效地提高诊断灵敏度和特异度。     

兰州市及东乡县汉族与东乡族学龄期儿童铁缺乏对照研究及相关因素分析

目的 了解兰州市与东乡县学龄期儿童铁缺乏、铁减少、缺铁性贫血患病率及影响因素,为预防和治疗铁缺乏提供参考依据。方法 2015年10月分别于兰州市及东乡县的两所学校抽取6~12岁儿童396名。进行体格发育指标测量、静脉血采集和调查问卷。分析血红蛋白、血清铁、血清铁蛋白等指标,对调查问卷进行多因素Logistic回归分析。结果 396例儿童中铁减少、缺铁性贫血、铁缺乏的患病率分别为12.6%、8.6%、21.2%;东乡县儿童铁减少、缺铁性贫血、铁缺乏的患病率均较兰州市高,差异有统计学意义(P<0.05);东乡族儿童铁减少、缺铁性贫血、铁缺乏的患病率均较汉族高,差异均具有统计学意义(P<0.05);不同性别儿童铁减少、缺铁性贫血、铁缺乏患病率差异无统计学意义(P>0.05);不同年龄组儿童缺铁性贫血患病率差异有统计学意义(P<0.05),但铁减少的患病率差异无统计学意义(P>0.05)。在13个相关因素中,婴儿期(6月龄后)喂养、零食食入及偏食(OR>1,P<0.05)对缺铁性贫血患病率有显著影响,经济水平、带养人学历、家中有亲属贫血、注意饮食搭配、用铁锅烹饪及肉食食入为缺铁性贫血保护因素。结论 兰州市及东乡县学龄期儿童铁缺乏患病率较前降低,隐性缺铁仍是目前重要问题。     

妊娠中期母亲铁营养对婴儿早期铁营养状况影响的研究

目的 研究母亲妊娠中期铁营养对婴儿早期铁营养状况的影响.方法 测定母亲妊娠中、后期及脐血血清铁蛋白(zerum ferritin,SF)及血常规,随访至婴儿3～5月龄测婴儿血常规、血清可溶性转铁蛋白受体(soluble transferrin receptor,sTIR).比较母亲不同铁营养状况与婴儿血清sTIR水平关系.结果 (1)100对母亲-婴儿完成全程随访,婴儿有39例铁缺乏,92.31%(36/39)的母亲妊娠中期铁缺乏.(2)母亲妊娠中期患铁缺乏症的婴儿早期铁缺乏检出率明显高于母亲中期铁营养正常婴儿(X2=11.567,P<0.005),母亲妊娠中期为缺铁性贫血的婴儿铁缺乏症检出率明显高于母亲妊娠中期为隐性铁缺乏的婴儿铁缺乏症检出率(X2=7.356,P<0.01);母亲妊娠中期缺铁的婴儿早期血清sTIR值明显增高(P<0.005);妊娠中期母亲存在缺铁性贫血、隐性铁缺乏的婴儿血清sTfR值差异无统计学意义(P>0.05).(3)妊娠中期母亲SF水平与3～5月龄婴儿sTIR值存在负相关性(r=-0.7552,P<0.01).结论 3～5月龄健康婴儿的贫血可能同胎儿期铁贮存不足有关;母亲妊娠中期缺铁可减少胎儿期铁贮存,影响婴儿早期的铁营养水平.     

铁强化婴儿营养米粉预防小儿贫血的效果

<正> 铁缺乏为全世界最常见的单一营养素缺乏症。我国小儿贫血患病率较高,多属缺铁性。本文报告一临床实验,观察应用铁强化婴儿米粉预防北京市婴儿贫血的效果。 对象和方法 一、对象:1986年8月,在北京城区及近郊区共选择344例1～13个月散居、大致健康的婴儿,分为实验组与对照组,实验组包括城区150例,郊区20例;对照组城区148例,郊     

Possible effects of antioxidant status on increased platelet aggregation in childhood iron-deficiency anemia

BACKGROUND: Alterations in platelet function and antioxidant status in children with iron-deficiency anemia (IDA) have been reported previously. The present study was performed to better understand possible interactions between these two systems. METHODS: Erythrocyte superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) activity and platelet function were evaluated in 15 children (aged 1 1/2-15 years) with IDA. The antioxidant enzyme activity was determined spectrophotometrically. Platelet aggregation and secretion studies were performed using impedance and bioluminescence methods, respectively. Ten age-matched healthy children were included as a control group. RESULTS: There were no differences in SOD and CAT activities between patients and controls. However, GSH-Px activity was significantly lower in the iron-deficient children. Platelet aggregation responses to collagen and ADP were also significantly higher in iron-deficient children than in controls. CONCLUSIONS: Decreased antioxidant defense in IDA may cause increased oxidant stress, which, in turn, may result in a tendency towards platelet aggregation.     

Association of Iron Supplementation Programs with Iron-Deficiency Anemia Outcomes among Children in Brazil

Anemia remains a condition with high prevalence in populations worldwide, and the prevalence of anemia among children under five years old in Brazil is approximately 40%, being higher in communities marked by social inequities. Diverse government programs during recent decades targeted iron-deficiency anemia, considering its impacts throughout the lifetime. The objective of this study was to investigate the effects of two government iron supplementation programs on health outcomes related to iron-deficiency anemia among children up to 4 years old in Brazilian municipalities. A longitudinal panel encompassing data from 5570 municipalities from 1998 to 2019 was investigated using a difference-in-differences framework with multiple interventions and distinct times of adhesion, and fixed-effects models were estimated to control for invariant municipal characteristics throughout the period in order to ensure comparability. The results indicate significant effects of the federal programs in reducing hospitalizations and lengths of stay due to iron-deficiency anemia, especially in non-poor municipalities. There was complementarity in the effects of the programs; however, neither of the programs influenced mortality rates. Thus, it is important to consider possible improvements in the operationalization of the programs, in order to achieve better results in the reduction of severe iron-deficiency anemia among children up to 4 years old.