T N Sheth, N K Choudhry, M Bowes, A S Detsky
The relation of conjunctival pallor to the presence of anemia.
J Gen Intern Med. 1997 Feb;12(2):102-6.
Abstract/Text
OBJECTIVE: To determine the value of conjunctival pallor in ruling in or ruling out the presence of severe anemia (hemoglobin < or = 90 g/L) and to determine the interobserver agreement in assessing this sign.
DESIGN: Patients were prospectively assessed for pallor by at least one of three observers. All observations were made without information of the patient's hemoglobin value or of another observer's assessment.
SETTING: Tertiary-care, university-affiliated teaching hospital.
PATIENTS: Three hundred and two medical and surgical inpatients.
MEASUREMENTS AND MAIN RESULTS: Likelihood ratios (LRs) calculated for conjunctival pallor present, borderline, and absent were as follows: pallor present, LR 4.49 (95% confidence interval [CI] 1.80, 10.99); pallor borderline, LR 1.80 (95% CI 1.18, 2.62); pallor absent, LR 0.61 (95% CI 0.44, 0.80). Kappa scores of interobserver agreement between paired observers were 0.75 and 0.54.
CONCLUSIONS: The presence of conjunctival pallor, without other information suggesting anemia, is reason enough to perform a hemoglobin determination. The absence of conjunctival pallor is not likely to be of use in ruling out severe anemia. With well-defined criteria, interobserver agreement is good to very good.
A Karnad, T R Poskitt
The automated complete blood cell count. Use of the red blood cell volume distribution width and mean platelet volume in evaluating anemia and thrombocytopenia.
Arch Intern Med. 1985 Jul;145(7):1270-2.
Abstract/Text
The availability of automated blood cell analyzers that provide an index of red blood cell volume distribution width (RDW) and a mean platelet volume (MPV) has led to new approaches to patients with anemia and thrombocytopenia. The RDW, which measures heterogeneity of the red blood cell population, complements the mean corpuscular volume in the differential diagnosis of anemia based on peripheral blood analysis. The MPV varies inversely but nonlinearly with the platelet count in normal individuals and is of value in assessing platelet production in the thrombocytopenic patient. The clinical applications of the RDW and MPV, which are currently reported on most routine blood cell counts, are discussed.
Lauren Hudak, Ameen Jaraisy, Saeda Haj, Khitam Muhsen
An updated systematic review and meta-analysis on the association between Helicobacter pylori infection and iron deficiency anemia.
Helicobacter. 2017 Feb;22(1). doi: 10.1111/hel.12330. Epub 2016 Jul 13.
Abstract/Text
BACKGROUND: We conducted an updated systematic review and meta-analysis to examine the prevalence of depleted iron stores among persons infected with Helicobacter pylori compared to uninfected ones. We also assessed the impact of anti-H. pylori eradication therapy plus iron therapy on ferritin and hemoglobin levels compared to iron therapy alone.
METHODS: A literature search was conducted using the databases Medline, the Cochrane Library, Cochrane Central Register of Controlled Trials, EMBASE, and the Science Citation Index Expanded. Observational studies with methodological quality score of 13 (median score) and above, on a scale of 0-16, and all randomized controlled trials (RCTs) were eligible for the meta-analyses. Pooled point estimates and 95% confidence intervals (CI) were obtained using the random effects model.
RESULTS: Compared to uninfected persons, H. pylori-infected individuals showed increased likelihood of iron deficiency anemia (14 observational studies); pooled OR 1.72 (95% CI 1.23-2.42); iron deficiency (pooled OR 1.33; 95% CI 1.15-1.54; 30 studies); and anemia (pooled OR 1.15; 95% CI 1.00-1.32; 23 studies). Meta-analyses of seven RCTs showed increased ferritin, standardized mean difference (SMD) 0.53 (95% 0.21-0.85), but not hemoglobin, SMD 0.36 (95% -0.07 to 0.78), Pv=.1, following anti-H. pylori eradication therapy plus iron therapy as compared with iron therapy alone. Significant heterogeneity was found among studies, as well as evidence of publication bias.
CONCLUSIONS: Current evidence indicates increased likelihood of depleted iron stores in relation to H. pylori infection. H. pylori eradication therapy, added to iron therapy, might be beneficial in increasing ferritin and hemoglobin levels.
© 2016 John Wiley & Sons Ltd.
Shohei Kikuchi, Masayoshi Kobune, Satoshi Iyama, Tsutomu Sato, Kazuyuki Murase, Yutaka Kawano, Kohichi Takada, Kaoru Ono, Tsuyoshi Hayashi, Koji Miyanishi, Yasushi Sato, Rishu Takimoto, Junji Kato
Prognostic significance of serum ferritin level at diagnosis in myelodysplastic syndrome.
Int J Hematol. 2012 May;95(5):527-34. doi: 10.1007/s12185-012-1048-3. Epub 2012 Mar 11.
Abstract/Text
Myelodysplastic syndrome (MDS) is characterized by peripheral blood cytopenias and risk of progression to acute myeloid leukemia. Elevated serum ferritin (SF), due to ineffective erythropoiesis and increased iron absorption from the gut, is often observed in non-transfused MDS patients, suggesting involvement of iron overload in its pathogenesis. However, the prognostic value of the baseline SF is unclear. We evaluated baseline SF levels in non-transfused MDS patients. The SF level was significantly higher in the 47 MDS patients in this study than in the healthy controls (P < 0.001). The SF level of higher-risk MDS patients (int-2/high) was significantly higher than that of the lower-risk MDS patients (low/int-1) (467 ± 354 vs. 277 ± 372 ng/ml, P < 0.001). The SF level in MDS patients with chromosomal abnormality was significantly higher than that in patients with normal karyotype. When patients were divided into the low SF group (<500 ng/ml) and high SF group (≥500 ng/mL), the survival time was significantly longer in the former group than the latter group (118.8 vs. 10.2 M, P = 0.002). Further, leukemia-free survival (LFS) was significantly longer in the low SF group than the high SF group (P = 0.010). Baseline SF level may, therefore, be a prognostic factor for overall survival and LFS in MDS patients.
Mehmet Erdogan, Erdogan Mehmet, Aybike Kösenli, Kosenli Aybike, Sencer Ganidagli, Mustafa Kulaksizoglu, Kulaksizoglu Mustafa
Characteristics of anemia in subclinical and overt hypothyroid patients.
Endocr J. 2012;59(3):213-20. Epub 2011 Dec 27.
Abstract/Text
Thyroid hormones stimulate directly or indirectly growth of erythroid colonies through erythropoietin. Anemia is often the first sign of hypothyroidism. Hypothyroidism can cause a wide variety of anemic disorders. Numerous mechanisms are involved in the pathogenesis of these anemias that can be microcytic, macrocytic and normocytic. We designed this study to investigate the anemia frequency and if present, etiology of anemia in hypothyroid patients. 100 patients with overt hypothyroid, 100 patients with subclinical hypothyroid, and 200 healthy controls were enrolled in this study. Overt hypothyroidism diagnosis is done when elevated TSH and low levels of free T4 and/or free T3 have been observed. Subclinical hypothyroidism is defined as elevated serum TSH with normal free T(4) and free T(3) levels. Peripheral smears of the anemic patients were examined. Anemia prevalence was 43% in the overt hypothyroid group, 39% in the subclinical hypothyroid group, and 26% in the control group (p=0.0003 and p=0.021 respectively related to controls). Thus, the frequency of anemia in subclinical hypothyroidism is as high as that in overt hypothyroidism. There was no difference between the hypothyroid groups in terms of anemia. Vitamin B12, Fe, and folic acid were similar between these groups. According to our findings, anemia of chronic disease is the most common type of anemia in hypothyroid patients. Suspicion of hypothyroidism should be considered in anemias with uncertain etiology.
Andrew G Gianoukakis, Mary J Leigh, Patrick Richards, Peter D Christenson, Aliza Hakimian, Paul Fu, Yutaka Niihara, Terry J Smith
Characterization of the anaemia associated with Graves' disease.
Clin Endocrinol (Oxf). 2009 May;70(5):781-7. doi: 10.1111/j.1365-2265.2008.03382.x. Epub 2008 Aug 15.
Abstract/Text
BACKGROUND: Graves' disease (GD) is associated with hyperthyroidism. Thyrotoxicosis adversely affects multiple organ systems including haematopoiesis. Anaemia occurring specifically in GD has not been systematically studied previously.
OBJECTIVE: To define the prevalence and characteristics of the anaemia associated with GD.
DESIGN: Eighty-seven newly diagnosed patients with GD were recruited. Haematological indices, thyroid function and inflammatory parameters were examined at presentation and following successful treatment of hyperthyroidism.
SETTING: Tertiary care academic referral centre.
RESULTS: Thirty-three per cent of subjects presented with anaemia. The prevalence of anaemia not attributable to other causes (GD anaemia) was 22%. GD anaemia affected 41.6% (10/24) of men compared to 17.5% of women (11/63). Mean erythropoietin (EPO) levels (15.5 +/- 5.3 mIU/ml) were within normal reference limits but significantly higher (P = 0.004) than those of the non-anaemic controls. Hgb correlated inversely with EPO (P = 0.05) and CRP (P = 0.04) levels, a relationship that persisted after multivariate adjustment for TT3 or TT4. With antithyroid therapy for 16 +/- 6.3 weeks, Hgb levels normalized in 8 out of 9 subjects with GD anaemia (10.7 +/- 0.8 to 13.5 +/- 1.3 g/dl, P = 0.0001). After normalization of Hgb, mean MCV and TIBC were significantly increased, and median ferritin and mean EPO were significantly decreased.
CONCLUSIONS: GD anaemia is common, resembles the anaemia of chronic disease, and is associated with markers of inflammation. It corrects promptly with return to the euthyroid state following treatment.
Natsuko Takahashi, Junichi Kameoka, Naoto Takahashi, Yoshiko Tamai, Kazunori Murai, Riko Honma, Hideyoshi Noji, Hisayuki Yokoyama, Yasuo Tomiya, Yuichi Kato, Kenichi Ishizawa, Shigeki Ito, Yoji Ishida, Kenichi Sawada, Hideo Harigae
Causes of macrocytic anemia among 628 patients: mean corpuscular volumes of 114 and 130 fL as critical markers for categorization.
Int J Hematol. 2016 Sep;104(3):344-57. doi: 10.1007/s12185-016-2043-x. Epub 2016 Jun 28.
Abstract/Text
There have been no studies on the distribution of causes of macrocytic anemia with respect to mean corpuscular volume (MCV) cutoff values. We retrospectively investigated the causes of macrocytic anemia (MCV ≥100 fL) among 628 patients who visited the outpatient hematology clinic in Tohoku University Hospital. To ensure data validity, we also analyzed data from 307 patients in eight other hospitals in the Tohoku district. The leading causes of macrocytic anemia (number of patients, %) were myelodysplastic syndromes (121, 19.3 %), suspected bone marrow failure syndromes (BMF; 74, 11.8 %), aplastic anemia (51, 8.1 %), plasma cell dyscrasia (45, 7.2 %), and vitamin B12 deficiency (40, 6.4 %) in Tohoku University Hospital. We made three primary findings as follows. First, the most common cause of macrocytic anemia is BMF. Second, lymphoid and solid malignancies are also common causes of macrocytosis. Third, macrocytic anemia may be classified into three groups: Group 1 (megaloblastic anemia and medications), which can exceed MCV 130 fL; Group 2 (alcoholism/liver disease, BMF, myeloid malignancy, and hemolytic anemia), which can exceed MCV 114 fL; and Group 3 (lymphoid malignancy, chronic renal failure, hypothyroidism, and solid tumors), which does not exceed MCV 114 fL. These conclusions were supported by the results from eight other hospitals.
