Risultati per: Anemia sideropenica e carenza marziale senza anemia: senza ferro si sta male

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A restrictive transfusion strategy is appropriate for most hospitalized patients.

Il nuovo farmaco Casgevy è prodotto da Vertex Pharmaceuticals Ltd. e CRISPR Therapeutics. Fino ad oggi, il trapianto di midollo osseo, procedura estremamente faticosa che comporta effetti collaterali molto spiacevoli, è stato l’unico trattamento di lunga durata per la talassemia

In a large trial, differences in key outcomes favoring a liberal transfusion strategy just missed statistical significance.

New England Journal of Medicine, Ahead of Print.

Circulation, Volume 148, Issue Suppl_1, Page A18863-A18863, November 6, 2023. Introduction:Blood volume status is a crucial input for care decisions, especially the use of diuretics for decongestion, in acute decompensated heart failure (ADHF). In the absence of direct measurements, total blood volume (TBV) status is typically measured via clinical assessment of external fluid overload (edema, jugular venous distension, etc.), and red blood cell volume (RBCV) is assessed via hematocrit. A recent retrospective analysis showed that direct blood volume assessment (BVA) leads to better outcomes in ADHF.Hypothesis:We hypothesize that BVA-guided ADHF care can be protocolized and integrated into clinical workflow of ADHF management.Methods:The objective of this study is to prospectively compare the efficacy of standard care treatment decisions to those in a BVA-guided fluid management protocol. ADHF patients admitted to a Veterans Affairs Medical Center were randomized to either a control (n=8) or BVA-guided (n=8) arm. TBV, plasma volume (PV) and RBCV were measured at admission and prior to discharge by BVA utilizing an I-131 labeled albumin indicator-dilution technique (Daxor BVA-100). Clinician assessments of volume status were collected for all patients prior to BVA measurement. TBV status was defined relative to patient norms as: Hypovolemic (< -10%), Euvolemic (-10% to +10%), Hypervolemic ( > +10%). RBCV status was defined as Anemic (< -10%) Not Anemic ( > -10%).Results:Measured volume status at admission was quite heterogeneous, with 62.5% Anemic, and with 37.5% Hypovolemic, 31.25% Euvolemic, and 31.25% Hypervolemic. Clinical assessment at admission was notably inaccurate, with only 56% accuracy (sensitivity 40%, specificity 83%) on the presence of anemia, and only 31% accuracy on the presence of hypervolemia, with 94% of patients assessed by clinicians as hypervolemic. Non-hypervolemic patients in the BVA-Guided group received less diuretic treatment than non-hypervolemic controls.Conclusions:We successfully embedded a BVA guided treatment protocol into the clinical workflow of ADHF management at a large medical center. Clinical assessment of volume status was less accurate that direct BVA. Future studies will address whether BVA guided treatment leads to better outcomes in ADHF.

Circulation, Volume 148, Issue Suppl_1, Page A16594-A16594, November 6, 2023. Background:Anemia may confer a poor prognosis among patients with acute coronary syndrome. However, contemporary data are lacking on the prognostic importance of anemia in patients with mildly reduced left ventricular (LV) systolic function after acute myocardial infarction (AMI).Methods:AMI patients receiving percutaneous coronary intervention were consecutively enrolled from January 2004 to August 2014. A total of 2,172 patients with mild LV systolic dysfunction: LV ejection fraction 40 49% as measured by echocardiography, were divided according to the presence of anemia. Anemia was defined as a hemoglobin level

Circulation, Volume 148, Issue Suppl_1, Page A12248-A12248, November 6, 2023. Introduction:Ventricular Tachycardia is a life threating arrhythmia with large admission amount. In this analysis, authors aim to investigate the impact of anemia in patients admitted due to ventricular tachycardia in terms of mortality, length of stay and total hospital charges.Methods:This is an analysis of the National Inpatient Sample Database of the years 2016-2020. Adult patients admitted non elective with a primary diagnosis of ventricular tachycardia, with or without a secondary diagnosis of anemia were identified using the ICD-CM codes. The primary outcome was mortality. Secondary outcomes were length of stay and resources utilization. Multivariate logistic analysis was performed, and outcomes were adjusted by age, gender, race, Charlson comorbidity index, hospital location, size, region, teaching status and insurance. Data was considered statistically significant with p-value

Circulation, Volume 148, Issue Suppl_1, Page A12145-A12145, November 6, 2023. Introduction:Women undergoing coronary artery bypass grafting (CABG) have higher mortality compared with men, yet its drivers are unclear.Hypothesis:The association of female sex with the risk of operative mortality after CABG may be mediated by intraoperative anemia.Aim:To investigate the relationship between sex, intraoperative anemia, and operative mortality.Methods:Retrospective cohort study of 1,434,225 isolated primary CABG patients (344,357 women) from the Adult Cardiac Surgery Database of the Society of Thoracic Surgeons (2011-2022). The primary outcome was operative mortality. The attributable risk (AR, quantifying the risk-adjusted strength of the association of female sex with CABG outcomes) was calculated. Causal mediation analysis adjusted for 42 baseline risk factors was used to derive the total effect of female sex on mortality risk and the proportion of that effect mediated by intraoperative anemia (nadir hematocrit). Spline regression evaluated the relationship of operative mortality and nadir intraoperative hematocrit.Results:Women had lower median preoperative hematocrit (36.9%, interquartile range [IQR] 33.3-40.0 vs 41.0% [37.4-44.0], standardized mean difference [SMD] 74.0%) and nadir intraoperative hematocrit (22.0% [20.0-25.0] vs 27.0% [24.0-30.0], SMD 97.0%) compared with men. Women had higher operative mortality than men (2.8% vs 1.7%, p

Circulation, Volume 148, Issue Suppl_1, Page A15589-A15589, November 6, 2023. Background:The impact of preprocedural anemia on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.Methods:We examined the clinical and angiographic characteristics and procedural outcomes of 8,633 CTO PCIs performed at 39 US and non-US centers between 2012 and 2023. Anemia was defined as a hemoglobin level of

Circulation, Volume 148, Issue Suppl_1, Page A13666-A13666, November 6, 2023. Background:Anemia in Type 2 Myocardial Infarction (T2MI) related hospitalizations has been linked to higher one year mortality along with other causes of hemodynamic stress. We conducted the first ever meta analysis to evaluate the overall global prevalence of Anemia among patients with T2MI with differences by subgroups.Methods:PUBMED, SCOPUS and Google Scholar Databases were systematically reviewed to find studies through January 2023 ascertaining prevalence of Anemia in T2MI. Binary Random Effects models were used to estimate the pooled prevalence and subgroup analysis of anemia in T2MI. Heterogeneity was assessed using I2statistics. Leave-One-Out sensitivity analysis was also performed.Results:A total of 16 cohorts with 28,629 patients, hospitalized with T2MI (Mean Age 74; SD13) revealed a 23.3% [95% CI 17.8% – 28.8%, I2-98.61%, P

Circulation, Volume 148, Issue Suppl_1, Page A18608-A18608, November 6, 2023. Introduction:Iron deficiency (ID) and iron deficiency anemia (IDA) are common among patients with heart failure (HF). They are associated with increased hospitalizations and all-cause mortality. Intravenous (IV) iron repletion has been associated with significant improvement in these outcomes, but is underutilized during HF admissions. Electronic medical record (EMR) based tools to increase recognition of ID and IDA in patients with HF and promote treatment with IV iron have not been described.We developed an EMR based tool to identify patients admitted with HF with ID and IDA who were candidates for IV iron repletion in an urban academic medical center.Hypothesis:ID and IDA are underdiagnosed and undertreated among patients admitted for HF. EMR based tools can be used to systematically identify patients with ID, IDA, and increase appropriate use of IV iron in patients with HF.Methods:Retrospective analysis of patients admitted with HF between March and May 2023. The EMR based tool defined HF by encounter diagnosis and use of IV diuretics, anemia by hgb of < 13 g/dl (male) and < 12 g/dl (female), ID by ferritin < 100 ng/ml or ferritin < 300 ng/ml and iron saturation < 20%, IDA by presence of ID and anemia, and if the patient received IV iron. Presence of HF, anemia, ID, IDA, and use of IV iron were confirmed by manual chart review.Results:The EMR based tool identified 116 patients admitted with a diagnosis of HF who received IV diuretics. In total, 103 (89.6%) had clinically decompensated HF by chart review. Three patients were excluded due to leaving AMA or on hospice. The average patient age was 63.8 years, 49 (50%) were male, and 50 (50%) were female, and 72 (73%) were African American (AA). In this sample, 81 (82%) had anemia, of which 47 (58%) had both ferritin and iron saturation levels collected during the admission. A total of 15 (19%) had no record for ferritin, iron saturation, or both. By including labs from prior admissions, a total of 64 (65%) of the 99 patients had ID while 57 (58%) had IDA. In total, 22 received IV iron (34% of patients with ID, 39% of patients with IDA).Conclusions:An EMR based tool can be used to identify patients with HF, ID, IDA, and the use of IV iron. ID and IDA are prevalent among patients with HF but remain underdiagnosed and undertreated.

In a trial involving older men with hypogonadism, testosterone treatment corrected mild anemia slightly more often than did placebo.

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