The longitudinal relationship of hemoglobin, fatigue and quality of life in anemic cancer patients: results from five randomized clinical trials.

BACKGROUND: Anemia is common in cancer and has been associated with fatigue and reduced health-related quality of life (HRQOL). We report the association between hemoglobin and fatigue and the impact of reducing fatigue on several domains of HRQOL. PATIENTS AND METHODS: These analyses were based on five randomized trials. Patients completed the Functional Assessment of Cancer Therapy (FACT) Anemia scales and numeric rating scales of Energy, Activity and Overall Health at baseline and after the 12-week treatment period. t-tests and linear regression models were used to evaluate associations. Analyses were stratified into three groups: solid tumor chemotherapy patients, lymphoproliferative malignancy chemotherapy patients and non-chemotherapy patients. RESULTS: Adjusted mean differences (95% CI) in FACT Fatigue change scores between hemoglobin responders (> or =2 g/dl increase) and non-responders were 3.0 (1.2, 4.7), 2.8 (0.6, 5.0) and 5.8 (2.2, 9.5) among the solid tumor, lymphoproliferative malignancy and non-chemotherapy groups, respectively. Significantly greater improvements (P <0.01) were observed in the FACT well-being scales for patients with meaningful improvement in fatigue (FACT Fatigue change score > or =3 points). After controlling for other factors, patients whose fatigue improved reported substantially greater improvements in energy, ability to perform usual activities and overall health (P <0.0001). CONCLUSIONS: Across five trials of cancer patients on and off chemotherapy, hemoglobin response was associated with meaningful improvements in fatigue, which, in turn, was associated with improved physical, functional, emotional and overall well-being.     

中药对免疫介导性再生障碍性贫血T淋巴细胞的实验研究

实验用Balb／c小鼠经亚致死剂量的射线照射后，输入取自DBA／2小鼠的胸腺淋巴结细胞来制作免疫介导性再障的模型。用正气活血、温补脾肾、扶正解毒中药煎出液，分别浓缩成含生药量为0．79g／ml浓度的药液灌胃，每日1次，每次0．5ml。探讨这些方药对免疫介导型再障的治疗效果和作用机理。结果表明：这些方药在不同程度上都能提高再障小鼠的TH细胞，降低TS细胞，使TH／TS比值升高，减轻免疫异常对骨髓造血细胞的抑制和损伤，有利于再障骨髓造血的修复和重建。提示了辨证论治对指导用药的重要性。     

Frequency and significance of anemia in non-Hodgkin's lymphoma patients

Objectives: Retrospective evaluation of anemia frequency and its prognostic value in patients with different subtypes of non-Hodgkin's lymphoma and comparison with other clinical characteristics.Patients and methods: Anemia was defined as a hemoglobin value less than or equal to 12 g/dl for all men and women over 50 years of age, and less than or equal to 11 g/dl for women under 50 years of age. The study included 1077 adult lymphoma patients treated between 1980 and 1995 with the following histologic subtypes: 127 patients with small lymphocytic or lymphoplasmacytoid, 62 with marginal zone, 50 with mantle-cell, 208 with follicular, 104 with T-cell lymphoma, 426 with diffuse large-cell and, finally, 73 patients with other high-grade lymphomas.Results: Anemia was present in 341 patients (32%). It was an adverse prognostic factor (P <; 0.0001) for overall survival (OS) and progression-free survival (PFS) but not for relapse-free survival (RFS). When patients with and those without bone marrow involvement were considered separately, anemia remained an adverse factor. Anemia was significantly associated with shorter PFS in small lymphocytic or lymphoplasmacytoid, mantle cell, diffuse large cell and high-grade lymphomas and with shorter OS in all histologic subgroups except marginal zone lymphoma. In multivariate analysis, anemia was a significant prognostic factor for OS and PFS for the population as a whole (P = 0.0001 and P = 0.0048, respectively) and in patients with bone marrow involvement (P = 0.007 and P = 0.005, respectively) but not in patients without bone marrow involvement. Finally, the addition of anemia to the International Prognostic Index led to an improvement for OS (P = 0.0004) and PFS (P = 0.0004).Conclusions: Anemia is an important adverse prognostic factor for the outcome of lymphoma patients, particularly in some histologic subgroups and in patients with bone marrow involvement.     

胃癌合并慢性病性贫血患者红细胞膜表面CD35和CD58的表达

目的研究细胞因子对正常人和胃癌伴慢性病性贫血(anemia of chronic cliseasis, ACD)的影响.方法采用ELISA方法测定CD35和CD58水平,红细胞酵母花环法测定RBC-C3bRR和RBC-ICR,聚乙醇沉淀比浊法测定CIC,流式细胞术测定CD2.结果胃癌组和正常对照组进行比较RBC-C3b差异有统计学意义,P<0.01;RBC-ICR差异有统计学意义,P<0.05;CD35差异有统计学意义,P<0.01;而CD58虽然低于正常对照组,但差异无统计学意义,P>0.05;CIC测定结果均正常.结论胃癌患者RBC-C3b、CD35和CD58水平下降与胃癌患者具有免疫活性的细胞因子有直接关系.但CD58无统计学意义.     

乙二胺四乙酸铁钠强化酱油预防儿童贫血的效果观察

目的　研究乙二胺四乙酸铁钠强化酱油预防缺铁性贫血高发地区儿童贫血的效果。方法　选择贵州省毕节市 9个村的儿童进行了为期 18个月的随机对照的双盲干预实验。在干预前和干预第 6、12和 18个月后分别测定了儿童末稍血血红蛋白含量 ,在干预前和干预 6个月后分别测量了儿童的身高、体重、上臂围和 3个部位的皮褶厚度。结果　强化组血红蛋白含量显著增高 [干预前 ( 111 0 8± 11 31)g L ,干预 12个月后 ( 12 2 99± 8 4 3)g L],贫血率显著下降 (干预前 5 8 0 % ,干预 12个月后 17 6 % ) ;干预 12个月后强化组儿童年龄别体重的增加值、三头肌和腹部皮褶厚度及其增加值显著高于对照组。结论　NaFeEDTA强化酱油可显著提高儿童血红蛋白水平 ,降低贫血患病率 ,促进儿童体重增长 ,增加皮下脂肪的积累。在缺铁性贫血高发儿童中应用NaFeEDTA强化酱油是预防缺铁性贫血的一种有效干预措施     

Is preoperative donation of autologous blood rational for radical retropubic prostatectomy?

PURPOSE: We investigated differences in the rate of homologous blood transfusion and the degree of anemia to determine whether it is rational to have patients donate autologous blood before radical prostatectomy. MATERIALS AND METHODS: We retrospectively reviewed the charts of 221 consecutive men who underwent radical retropubic prostatectomy performed by 1 surgeon in a 14-month period. About half of the patients donated autologous blood preoperatively. We evaluated perioperative hemoglobin, and the rate of autologous and homologous transfusion. RESULTS: The groups did not significantly differ in terms of demographic data, co-morbid conditions, clinical variables or hospitalization. Preoperatively mean hemoglobin plus or minus standard deviation was 13.4 +/- 1 and 14.7 +/- 1 gm./dl. in patients who did and did not donate blood, while homologous transfusion was required in 1 (1%) and 4 (3.5%), respectively (p = 0. 18). At hospital discharge anemia was more prevalent in nondonors. Of the men who did versus did not donate blood hemoglobin was less than 10 and less than 9 gm./dl. in 8.4% versus 34% (p <0.0001), and 12.5% versus 0% (p <0.0004), respectively. CONCLUSIONS: Our retrospective review of a cohort of patients who underwent radical retropubic prostatectomy showed no difference in homologous blood transfusion based on preoperative autologous donation status. Autologous donors had lower hemoglobin preoperatively, a higher rate of transfused units and higher hemoglobin at hospital discharge. Preoperative donation of autologous blood may not decrease the need for homologous transfusion in healthy patients undergoing radical retropubic prostatectomy.     

MATERNAL ANEMIA AND POSTPARTUM WEIGHT CHANGE ASSOCIATED WITH DECREASED MATERNAL-INFANT INTERACTION IN A RURAL KENYAN POPULATION

Associations between maternal nutritional factors including energy intake, body mass index, postpartum weight change, and anemia status and maternal-infant interactions were examined in 124 mother-infant pairs from a marginally malnourished, rural Kenyan population. Anemic mothers spent less time holding and caring for their infants than nonanemic mothers. Mothers who retained their pregnancy weight gain or were able to gain weight postpartum spent more time looking at their infants than mothers who lost weight postpartum. Maternal food intake per se was not associated with patterns of infant interaction. Lower birth weight infants were held more, cared for more, and looked at face-to-face more by their mothers. Older sisters tended to be more involved in infant interactions with higher birth weight infants.     

Sickle cell anemia and hematopoietic cell transplantation: When is a pound of cure worth more than an ounce of prevention?

Abstract:  Hematopoietic cell transplantation (HCT) is curative therapy for sickle cell anemia (SCA). However, its widespread use is constrained by donor availability and by concerns about its short-term and long-term toxicities. Current efforts to identify suitable candidates for HCT, to decrease the toxicity of HCT, and to broaden its availability are discussed.     

甘草酸对免疫诱导再生障碍性贫血小鼠骨髓造血功能的影响

目的:探讨甘草酸对免疫诱导再生障碍性贫血(再障)小鼠骨髓造血功能的影响,寻求治疗免疫诱导再障的方法。方法:BALB/c小鼠72只,适应性喂养1周后,随机分为实验组(64只)及正常对照组(8只)。实验组小鼠首先制造再障模型。将制模后小鼠再分为模型对照组(40只)及甘草酸组(24只)。将甘草酸组再分为低、中、高剂量组,每组8只,低、中、高剂量组小鼠每天经灌胃分别给予10、20、30mg/(kg.d)甘草酸,连续14 d,于第15天脱臼处死小鼠,分别检测血象、骨髓单个核细胞(BMNC)、CFU-GM、BFU-E,用原位末端标记法(TUNEL)测定胸腺淋巴结混合细胞、骨髓单个核细胞、外周血单个核细胞凋亡率。其余40只模型对照组小鼠每天经灌胃给予等体积生理盐水,并分别于第3、5、7、10、15天各处死一批次小鼠。8只正常对照组小鼠只给予等体积生理盐水。检测指标同上。结果:甘草酸组WBC、Hb、BMNC、CFU-GM、BFU-E明显高于模型对照组(P<0.05,P<0.01),且具有剂量-效应关系。模型对照组骨髓单个核细胞凋亡率、胸腺淋巴结混合细胞凋亡率、外周血单个核细胞凋亡率均高于正常对照组(P<0.01)。甘草酸组骨髓单个核细胞凋亡率高于正常对照组(P<0.01)而低于模型对照组(P<0.01),外周血单个核细胞凋亡率高于正常对照组及模型对照组(P<0.05,P<0.01),胸腺淋巴结混合细胞凋亡率高于正常对照组(P<0.01)。结论:甘草酸通过促进成熟淋巴细胞凋亡而有助于免疫诱导再障小鼠骨髓造血功能的恢复。