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PubMed2002

The relationship between admission hemoglobin level and outcome after hip fracture.

OBJECTIVE: To determine the effect of admission hemoglobin level on patient outcome after hip fracture. STUDY DESIGN: Prospective, consecutive. PATIENTS: From July 1991 to June 1997, 395 community-dwelling patients sixty-five years of age or older who had sustained an operatively treated femoral neck or intertrochanteric fracture were prospectively followed up. MAIN OUTCOME MEASUREMENTS: Postoperative complications, in-hospital mortality rate, hospital length of stay, hospital discharge status, place of residence at one year, and mortality and recovery of ambulatory ability and activities of daily living status at three, six, and twelve months. RESULTS: Women with admission hemoglobin levels below 12.0 grams per deciliter and men with admission hemoglobin levels below 13.0 grams per deciliter were classified as anemic. One hundred eighty patients (45.6 percent) were considered anemic on admission. Patients who were anemic were more likely to have an American Society of Anesthesiologists rating of III or IV and have sustained an intertrochanteric fracture. Hospital length of stay and mortality rate at six and twelve months were significantly higher for patients who were anemic on admission. There were no differences in the incidence of postoperative complications, hospital discharge status, place of residence at one year, in-hospital mortality rate, and three-month mortality rate between patients who were and were not anemic on admission. In addition, there were no differences in the recovery of ambulatory ability and of basic and instrumental activities of daily living status at three, six, and twelve months between the two patient groups. CONCLUSIONS: Patients at risk for poor outcomes after hip fracture can be identified by assessing hemoglobin levels at hospital admission.

Aged↗
PubMed2000

High and low hemoglobin levels during pregnancy: differential risks for preterm birth and small for gestational age.

OBJECTIVE: To examine the association of maternal hemoglobin during pregnancy with preterm birth and small for gestational age (SGA). METHODS: We performed a retrospective cohort analysis of hemoglobin and birth outcome among 173,031 pregnant women who attended publicly funded health programs in ten states and delivered a liveborn infant at 26-42 weeks' gestation. We defined preterm as less than 37 weeks' gestation and SGA as less than the tenth percentile of a US fetal growth reference. RESULTS: Risk of preterm birth was increased in women with low hemoglobin level in the first and second trimester. The odds ratio (OR) for preterm birth with moderate-to-severe anemia during the first trimester (more than three standard deviations [SD] below reference median hemoglobin, equivalent to less than 95 g/L at 12 weeks' gestation) was 1.68 (95% confidence interval [CI] 1.29, 2. 21). Anemia was not associated with SGA. High hemoglobin level during the first and second trimester was associated with SGA but not preterm birth. The ORs for SGA in women with very high hemoglobin level during the first and second trimester (more than three SDs above reference median hemoglobin, equivalent to greater than 149 g/L at 12 weeks' gestation and greater than 144 g/L at 18 weeks') were 1.27 (95% CI 1.02, 1.58) and 1.79 (95% CI 1.49, 2.15), respectively. CONCLUSION: These data highlight the importance of considering anemia and high hemoglobin level as indicators for adverse pregnancy outcome. An elevated hemoglobin level (greater than 144 g/L) is an indicator for possible pregnancy complications associated with poor plasma volume expansion, and should not be mistaken for good iron status.

Adolescent↗
PubMed1998

Pica practices of pregnant women are associated with lower maternal hemoglobin level at delivery.

OBJECTIVE: To determine the prevalence of pica during pregnancy, maternal hemoglobin levels at delivery, and the association of pica with 2 adverse pregnancy outcomes: low birth weight and preterm birth. DESIGN: A retrospective cohort study was conducted using eligible subjects (n=281) from a cross-sectional survey (n=366). SUBJECTS/SETTING: Mothers aged 16 to 30 years with infants younger than 1 year of age who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were interviewed at 4 WIC clinics in Houston and Prairie View, Tex. Medical records from 31 hospitals were abstracted. MAIN OUTCOME MEASURES: Maternal hemoglobin levels at delivery, mean birth weight, and mean gestational age were compared for women who reported pica and women who did not. STATISTICAL ANALYSES: Chi(2) tests, orthogonal t tests, analysis of variance, and regression analysis were used to test the relationships among study variables. RESULTS: Pica prevalence categorized by substance was as follows: ice, 53.7%; ice and freezer frost, 14.6%; other substances such as baking soda, baking powder, cornstarch, laundry starch, baby powder, clay, or dirt, 8.2%; and no pica, 23.5%. Women in all 3 pica groups had lower hemoglobin levels (mean+/-standard deviation, 114+/-12 g/L, 110+/-13 g/L, and 113+/-12 g/L, respectively) at delivery than women who did not report pica (118+/-11 g/L) (P<.01 for all pica groups vs no pica). There were no differences in mean birth weight or mean gestational age of infants born to women from the 3 pica groups and the No Pica group. APPLICATIONS: The findings suggest that pica practices are associated with significantly lower maternal hemoglobin levels at delivery but are not associated with pregnancy outcomes. Dietitians should ask pregnant women with anemia about pica and should counsel women who report pica regarding the health risks associated with it.

Adolescent↗
PubMed2006

Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study.

BACKGROUND: Previous studies have associated reduced hemoglobin levels with increased adverse events in heart failure. It is unclear, however, whether this relation is explained by underlying kidney disease, treatment differences, or associated comorbidity. METHODS AND RESULTS: We examined the associations between hemoglobin level, kidney function, and risks of death and hospitalization in persons with chronic heart failure between 1996 and 2002 within a large, integrated, healthcare delivery system in northern California. Longitudinal outpatient hemoglobin and creatinine levels and clinical and treatment characteristics were obtained from health plan records. Glomerular filtration rate (GFR; mL.min(-1).1.73 m(-2)) was estimated from the Modification of Diet in Renal Disease equation. Mortality data were obtained from state death files; heart failure admissions were identified by primary discharge diagnoses. Among 59,772 adults with heart failure, the mean age was 72 years and 46% were women. Compared with that for hemoglobin levels of 13.0 to 13.9 g/dL, the multivariable-adjusted risk of death increased with lower hemoglobin levels: an adjusted hazard ratio (HR) of 1.16 and 95% confidence interval (CI) of 1.11 to 1.21 for hemoglobin levels of 12.0 to 12.9 g/dL; HR, 1.50 and 95% CI, 1.44 to 1.57 for 11.0 to 11.9 g/dL; HR, 1.89 and 95% CI, 1.80 to 1.98 for 10.0 to 10.9; HR, 2.31 and 95% CI, 2.18 to 2.45 for 9.0 to 9.9; and HR, 3.48 and 95% CI, 3.25 to 3.73 for <9.0 g/dL. Hemoglobin levels > or = 17.0 g/dL were associated with an increased risk of death (adjusted HR, 1.42; 95% CI, 1.24 to 1.63). Compared with those with a GFR > or = 60 mL . min(-1).1.73 m(-2), persons with a GFR <45 mL.min(-1).1.73 m(-2) had an increased mortality risk: adjusted HR, 1.39 and 95% CI, 1.34 to 1.44 for 30 to 44; HR, 2.28 and 95% CI, 2.19 to 2.39 for 15 to 29; HR, 3.26 and 95% CI, 3.05 to 3.49 for <15; and HR, 2.44 and 95% CI, 2.28 to 2.61 for those on dialysis. Relations were similar for the risk of hospitalization. The findings did not differ among patients with preserved or reduced systolic function, and hemoglobin level was an independent predictor of outcomes at all levels of kidney function. CONCLUSIONS: Very high (> or = 17 g/dL) or reduced (<13 g/dL) hemoglobin levels and chronic kidney disease independently predict substantially increased risks of death and hospitalization in heart failure, regardless of the level of systolic function. Randomized trials are needed to evaluate whether raising hemoglobin levels can improve outcomes in chronic heart failure.

Adult↗
PubMed1998

The relationship of pretreatment serum hemoglobin level to the survival of epithelial ovarian carcinoma patients: a prospective review.

BACKGROUND: Tumor anemia is a common symptom in cancer patients. This study assessed the prognostic relationship of pretreatment serum hemoglobin levels to survival in a retrospective sample of 206 patients with epithelial ovarian carcinoma. METHODS: Survival analysis was evaluated by univariate (Kaplan-Meier product limit method and log rank test) and multivariate (Cox proportional hazards model) analysis. Mean values were compared by the Kruskal-Wallis test. Serum hemoglobin levels were determined in each patient 24-48 hours before surgery. Anemia was defined as a serum hemoglobin value below 12 g/dL. RESULTS: Tumor anemia was present in 32% of the patients before primary surgery. Hemoglobin levels were significantly lower in patients with residual tumor than in those with no detectable residual tumor after initial surgery (P = 0.008). Although statistically not significant, we found a trend toward lower hemoglobin levels with advanced stage of disease. For 5 years, overall survival probability was 38.5% and 52.3% for patients with pretreatment hemoglobin levels P = 0.008). In multivariate analysis, the relative risk of death was significantly associated with decreasing serum hemoglobin levels. No interaction was found between the grade of anemia and chemotherapy or radiation therapy with respect to its influence on overall survival. CONCLUSIONS: After adjustment for established prognostic factors, tumor anemia was found to have an independent relationship to the overall survival of patients with ovarian carcinoma. Because no significant interaction could be found between the grade of anemia and chemotherapy, marked tumor anemia was considered an indicator of the presence of biologically aggressive tumor cell clones.

Adult↗
PubMedDate not supplied

Impact of weekly treatment with ferrous sulfate on hemoglobin level, morbidity and nutritional status of anemic infants.

OBJECTIVE: To evaluate the impact of weekly treatment with ferrous sulfate on hemoglobin level, morbidity and nutritional status in a sample of anemic infants from Zona da Mata Meridional in the state of Pernambuco, Brazil. METHODS: A controlled, community-based intervention was carried out with 378 infants who were followed-up for 18 months. Hemoglobin level was measured at 12 months in a total of 245 children randomly selected. Participating infants were divided into three groups: two received 45 mg of elemental iron weekly, from 12 to 18 months of life (69 children with moderate/severe anemia, and 111 with mild anemia); the third group was composed of 65 non-anemic children, who received no intervention. The remaining 133 children constituted the control group, for comparisons on nutritional status and morbidity. RESULTS: The prevalence of anemia was 73.5% at 12 months of life. After 6 months of treatment, 42.3% of anemic children reached hemoglobin levels >or= 11.0 g/dL. The mean increase was 1.6 g/dL, being higher (2.5 g/dL) in the group with lower levels of hemoglobin at baseline. Children without anemia at baseline received no treatment, and 40.3% of them became anemic at the end of follow-up, with a mean decrease of 0.5 g/dL in hemoglobin levels. A significantly greater weight gain was observed in the two treated groups, while no significant improvements were seen in linear growth and duration of diarrhea. CONCLUSIONS: The fact that less than half the children receiving ferrous sulfate recovered from anemia at the end of follow-up, along with the development of anemia in many untreated, previously non-anemic infants, suggests the need for effective control strategies.

Anemia↗
PubMed1984

Erythrocyte count and hemoglobin levels in diabetic women.

Fasting blood glucose, erythrocyte counts hemoglobin levels of 131 Libyan diabetic women of Tripoli , Libya were determined. The respective mean values were 223 +/- 7 mg X dl-1, 4.97 +/- 0.034 X 10(6) X mm-3 and 14.4 +/- 0.127 g X dl-1. Sixty-five percent of these diabetic women were obese. The highest percent of diabetics belong to the age group 46-55 years. The increase in prevalence of diabetes correlates with an increase in obesity. A significant positive correlation was found between body surface area and fasting blood glucose levels (r = 0.65; P less than 0.001). Elevated levels of erythrocyte count and hemoglobin were present in these diabetic patients. Significant correlations were found between body surface area and erythrocyte count, as well as between fasting blood glucose levels and erythrocyte count, indicating the effect of obesity and diabetes on erythrocyte numbers. A significant correlation was found between fasting blood glucose levels and hemoglobin (r = 0.35; P less than 0.001). The elevated levels of hemoglobin present in these patients may be the result of haemoconcentration due to polyuria, which is always present in poorly controlled diabetic patients. The results suggest a close relationship between diabetes and obesity. Regulation of body weight/surface area is an important factor in the control of diabetes. The elevated levels of erythrocyte count and hemoglobin reflect poor control of blood glucose levels in these diabetic patients.

Adolescent↗
PubMed2005

[Impact of pre-radiotherapy hemoglobin level on local control of nasopharyngeal carcinoma].

BACKGROUND & OBJECTIVE: Oxygen increases tumor sensitivity to radiotherapy; tumor hypoxia is more prevalent in tumor patients with pretreatment hemoglobin concentration of < 130 g/L. This study was to evaluate impact of pre-radiotherapy hemoglobin level on radiotherapy outcome of nasopharyngeal carcinoma (NPC) patients. METHODS: Clinical and follow-up data of 166 NPC patients received definitive radiotherapy from 1999 to 2000 were reviewed. Pre-radiotherapy hemoglobin levels were stratified as high (> or =130 g/L) and low (< 130 g/L). Cox regression analysis was used to determine factors affecting local control. RESULTS: The median pre-radiotherapy hemoglobin level of the 166 patients was 135 (85-189) g/L. Hemoglobin was < 130 g/L in 68 (41%) patients, and > or =130 g/L in 98 (59%) patients. The pre-radiotherapy hemoglobin level of < 130 g/L was related to low 3-year local relapse-free survival rate (78% vs. 90%, P=0.015), but had no relations with distant metastasis-free survival (75% vs.77%, P=0.763) and overall survival rates (73% vs. 83%, P=0.056). Multivariate analysis showed that pre-radiotherapy hemoglobin level, T stage, and gender were independent prognostic factors for local failure. CONCLUSIONS: Pre-radiotherapy hemoglobin of < 130 g/L is a prognostic factor for local control of NPC. Strategies for maintaining pre-radiotherapy hemoglobin of > or =130 g/L before radiotherapy and during treatment should be further explored.

Adolescent↗
PubMed2003

Determination of hemoglobin levels in the finger using near infrared spectroscopy.

We previously demonstrated that near-infrared spectroscopy can be used to measure blood flow. The spectrum of blood is dominated by hemoglobin. Therefore, it should be possible to determine the concentration of hemoglobin in tissue using near-infrared transmittance. We attempted to do this in the finger using a unique handheld multiple wavelength spectrophotometer. We took samples from 73 subjects and performed repeat measurements in several subjects. Hemoglobin level was determined at the time of near-infrared measurement. We performed correlation analysis between the hemoglobin values and the absorbance values. There was a strong correlation between hemoglobin levels and the 14 wavelengths (r = 0.738, n = 121, SEE = 1.7). We categorized the patients by hemoglobin level as either normal (12-16 g/dl), mildly anemic (10-12 g/dl), or moderately anemic (<10 g/dl). There were 21 patients in the low hemoglobin group, 29 in the middle range, and 23 in the normal range. The mean hemoglobin levels were 8.4 +/- 0.3 g/dl for the low group, 10.9 +/- 0.1 g/dl for the mildly anemic group, and 13.8 +/- 0.3 g/dl for the group with normal hemoglobin. There was a clear separation of absorbance values among the three groups. The major differences seen were in the midrange of the spectrum. It is encouraging that this first study of hemoglobin measurement yielded data permitting a discrimination of hemoglobin levels. It is hoped that future refinements will lead eventually to a non-invasive technique for the measurement of blood hemoglobin concentration.

Anemia↗
PubMed1986

The influence of hemoglobin level on the regression and long term local control of transitional cell carcinoma of the bladder following photon irradiation.

Patients with transitional cell carcinoma of the bladder treated by radical megavoltage X ray therapy are analyzed. There was a significant correlation between tumor T stage classification and the hemoglobin level at the start of radical radiotherapy. A hemoglobin level of 12g/dl or more was associated with a significant improvement in complete local tumor regression at 6 months and durable local tumor control for patients with T3 cancer or a cancer of grade 3 histology. Hemoglobin level did not influence survival for patients with T1 or grade 1 cancer. Those patients with T2-T4 cancer, grade 2-3 cancer, or a cancer of solid or mixed appearance had a significantly better survival probability if their hemoglobin level was more than 13g/dl. Hemoglobin level would appear to exert its influence on survival by an effect on local tumor control. It has no significant independent effect on the hazard of distant metastases.

Carcinoma, Transitional Cell↗
PubMed1984

Smoking, hemoglobin levels, and birth weights in normal pregnancies.

Of 811 otherwise healthy, nonanemic, pregnant Norwegian women, 43% smoked during the third trimester. No significant association existed between smoking habits and hemoglobin levels during the third trimester, but the fairly small number of heavy smokers (greater than 10 cigarettes per day) may have precluded the discovery of subtle true differences. Birth weights were transferred to a weight-for-dates percentile scale, based on the distribution of the total Norwegian birth population over an 11-year period. With a grouping in quartiles according to this scale, a strong correlation between smoking habits and low birth weights emerged, with 47% of newborn infants of heavy smokers falling in the lowest quartile. Levels of hemoglobin were inversely correlated to birth weight quartiles, equally in mothers who smoked and those who did not smoke. However, when birth weights were grouped according to maternal hemoglobin at term, the tobacco-related effect on birth weight appeared only with levels of hemoglobin above 12 gm/dl, being particularly strong for levels above 13 gm/dl. Hemoglobin levels of 9.0 to 11.9 gm/dl appeared to protect from growth retardation the fetuses of nonanemic mothers who smoked. Studying ponderal, or weight-by-length, indices, we found that growth-retarded babies of mothers who smoked tended to be thin, thus indicating that they had been deprived of nutrients.

Adult↗
PubMed2005

Hepcidin levels in humans are correlated with hepatic iron stores, hemoglobin levels, and hepatic function.

Hepcidin, a key regulator of iron metabolism, is synthesized by the liver. Hepcidin binds to the iron exporter ferroportin to regulate the release of iron into plasma from macrophages, hepatocytes, and enterocytes. We analyzed liver samples from patients undergoing hepatic surgery for cancer or receiving liver transplants and analyzed correlations between clinical parameters and liver hepcidin mRNA and urinary hepcidin concentrations. Despite the many potential confounding influences, urinary hepcidin concentrations significantly correlated with hepatic hepcidin mRNA concentrations, indicating that hepcidin quantification in urine is a valid approach to evaluate hepcidin expression. Moreover, we found in humans that hepcidin levels correlated with hepatic iron stores and hemoglobin levels and may also be affected by hepatic dysfunction.

Adult↗
PubMed2004

Hemoglobin levels during radiation therapy and their influence on local control and survival of patients with endometrial carcinoma.

Anemia is a common complication of cancer that has been associated with poor response to treatment and decreased survival in a number of malignancies. By chart review the effects of prognostic factors (e.g. age, body mass index, tumor stage) and hemoglobin levels, measured prior to and during adjuvant (724/996; 72.7%) and primary radiotherapy (185/996; 18.6%) in 996 endometrial cancer patients treated between 1986 and 1998 were investigated using Kaplan-Meier survival on disease-free and overall survival. Preoperative hemoglobin levels were of no prognostic value. Patients with normal hemoglobin had an improved survival during primary radiotherapy (p<0.05). Anemia and course of hemoglobin during adjuvant radiotherapy were significantly associated with poor survival in patients undergoing adjuvant radiotherapy (p=0.001). Cox regression analysis confirmed these findings for adjuvant treatment. Local recurrences were also less frequently observed in patients with normal hemoglobin levels (p=0.044). Hemoglobin levels prior to and during radiotherapy seem to be important with respect to treatment outcome for endometrial cancer. This finding supports the use of measures to maintain adequate hemoglobin levels (transfusions, erythropoietin) to improve local control and patient survival.

Aged↗
PubMed2006

Influence of hemoglobin levels on survival after radical treatment of esophageal carcinoma with radiotherapy.

INTRODUCTION: The objective was to investigate the possible prognostic value of blood hemoglobin concentration in the outcome of radical treatment for locally advanced esophageal carcinoma. MATERIALS AND METHOD: This was a retrospective analysis of data for 85 patients treated for locally advanced esophageal carcinoma between January 1991 and January 1997 with chemoradiotherapy alone or as neoadjuvant therapy. All patients received chemotherapy (4 cycles of cisplatin 100 mg/m2 on day 1, and continuous infusion 5-fluorouracil 1 g/m2 per day on days 1-5) with concomitant radiotherapy (40 Gy at 2 Gy/session to the esophageal tumor and mediastinum). The response was evaluated after 4 weeks. 69 patients continued to receive chemoradiotherapy only to a total dose of 60-64 Gy to the esophageal tumor with a 2-cm margin. Sixteen patients underwent radical surgery. Hemoglobin levels were measured before combined treatment in all patients. The prognostic value of hemoglobin concentration was analyzed statistically, along with other patient-, tumor- and treatment-related factors. RESULTS: Mean follow-up time: 82 months (range 60- 99 months). Chemoradiotherapy was followed by an overall clinical response of 69.4%, with complete clinical response in 24.7% of the patients. Mean survival time was 12 months, and overall likelihood of survival after 3 years was 13%. Mean time to progression: 5 months. Median survival time was 12 months in the 69 patients who underwent chemoradiotherapy alone, and 26 months in patients who underwent radical surgery. Univariate analysis showed a hemoglobin value of > 13 g/dl to be a prognostic factor for better survival, along with performance status according to the ECOG classification, weight loss < 10%, tumor stage, tumor length, and complete response to chemoradiotherapy. Multivariate analysis showed that only hemoglobin concentration was an independent prognostic factor: for each unit increase in hemoglobin level, the risk of death from esophageal carcinoma decreased by 5%. In the subgroup of patients who did not undergo surgery, hemoglobin concentration was also an independent prognostic factor along with complete clinical response. CONCLUSIONS: As found for other solid tumors, hemoglobin level was a determining factor in the prognosis for treatment outcome in patients with esophageal carcinoma. Our findings require confirmation in randomized studies and further documentation of the probable benefits of correcting hemoglobin levels.

Adenocarcinoma↗
PubMed2004

Hemoglobin levels and skeletal muscle: results from the InCHIANTI study.

BACKGROUND: Anemia is associated with reduced physical performance and muscle strength. The aim of the study was to explore whether anemia and hemoglobin levels are associated with differences in quantitative and qualitative measures of muscle and fat. METHODS: The study sample consisted of 909 participants 65 years and older enrolled in the "Invecchiare in Chianti" (InCHIANTI) study, a prospective population-based study of older people aimed at identifying risk factors for late-life disability. All the analyses were performed considering continuous hemoglobin levels as well as the dichotomous anemia variable (defined according to World Health Organization criteria as hemoglobin <12 g/dL in women and <13 g/dL in men). A peripheral quantitative computed tomography (pQCT) scan was performed in all participants to evaluate total, muscular, and fat cross-sectional areas of the calf and relative muscle density. Ankle extension strength was measured using a hand-held dynamometer. Linear regression analyses were used to assess the multivariate relationship of pQCT and skeletal muscle strength measures with hemoglobin levels and anemia after adjustment for demographics, chronic conditions, medication use, and other biological variables. RESULTS: Participants were aged 74.8 +/- 6.8 years. In our sample, 94 participants (10.3%) were anemic. Hemoglobin levels were significantly associated with muscle density (beta = 0.225 [SE, standard error 0.098], p=.02), muscle area/total area ratio (beta=0.778 [SE 0.262], p=.003), fat area/total area ratio (beta=-0.869 [SE 0.225]; p<.001). Skeletal muscle strength and muscle density were highly associated with anemia (beta=-3.266 [SE 1.173], p=.005 and beta=-0.816 [SE 0.374], p=.03, respectively). Results did not change when analyses were rerun in a restricted sample of participants not affected by major medical conditions. CONCLUSION: The present study shows that hemoglobin levels are associated with the parameters of body composition obtained by pQCT, and that decreases in muscular strength measures occur in the presence of anemia.

Aged↗
PubMedDate not supplied

[Effectiveness of postoperative autologous blood transfusion after knee replacement surgery and influence of preoperative hemoglobin level].

OBJECTIVE: To evaluate the effectiveness of postoperative autologous blood transfusion on reducing the need for allogenic transfusion during recovery from total knee arthroplasty until hospital discharge, and to determine whether effectiveness is related to preoperative hemoglobin level. MATERIAL AND METHODS: Retrospective study of patients undergoing surgery at Hospital Jerez de la Frontera, Spain, in 2003, assessing the association between postoperative autologous blood transfusion, preoperative hemoglobin, and allogenic transfusion requirements. RESULTS: A total of 107 patients were studied. Eighty-three received autologous blood transfusions after surgery and 15 (14.02%) required allogenic transfusion. The rate of allogenic transfusion was higher in association with hemoglobin levels exceeding 13 g x dL(-1) (P=0.003) and it was lower in patients who received autologous blood transfusions (P=0.046). In patients who received autologous transfusion, preoperative hemoglobin level and risk of allogenic transfusion were unrelated. When autologous transfusion was not given, allogenic transfusion risk was higher when hemoglobin concentration was less than 13 g x dL(-1) (P=0.0008). Autologous transfusion had a significant effect when hemoglobin level was less than 13 g x dL(-1) (P=0.002) but did not affect the rate of transfusion when hemoglobin was 13 g x dL(-1) or more. CONCLUSIONS: Autologous blood transfusion is effective for reducing the need for allogenic transfusion after knee replacement surgery, particulary when a patient's hemoglobin level is less than 13 g x dL(-1).

Aged↗
PubMed2005

Pretreatment serum hemoglobin level as a predictive factor of response to neoadjuvant chemotherapy in patients with locally advanced squamous cervical carcinoma: a preliminary report.

OBJECTIVE: The aim of this study was to evaluate the predictive value of pretreatment serum hemoglobin level (Hb) together with a series of clinical and pathological variables available before neoadjuvant chemotherapy in locally advanced squamous cervical cancer. METHODS: The influence on response to neoadjuvant chemotherapy of a series of pretreatment clinico-pathological features: hemoglobin level at diagnosis, age, parity, menopausal status, body mass index, clinical stage, tumor diameter, and nuclear grading were analyzed on 73 patients with locally advanced cervical cancer treated with platinum-based neoadjuvant chemotherapy followed by radical surgery. The relationships between pretreatment variables and response to chemotherapy were assessed in univariate and multivariate settings. A univariate and multivariate logistic regression model was adapted to predict an "optimal" response (pathological complete response or more than 50% reduction in tumoral diameter) or "sub-optimal" response (<50% reduction in tumoral diameter). RESULTS: Seventy-three patients-clinical stage: Ib2: 29 (39.7%) IIa: 22 (30.1%) IIb: 22 (30.1%)-received 3 cycles of platinum-based neoadjuvant chemotherapy followed by type III radical hysterectomy. A complete response to neoadjuvant chemotherapy was significantly associated with higher level of pretreatment hemoglobin (mean 14.0 mg/dl) compared to patients with > or =50% response (12.7 mg/dl) or <50% (11.9 mg/dl) (P = 0.002). At multivariate analysis, Hb level was found to be the most powerful and significantly related factor to response to neoadjuvant chemotherapy. A hemoglobin threshold of 12 mg/dl was able to distinguish between patients-with > or =12 mg/dl-at higher probability to respond to neoadjuvant chemotherapy from the ones at lower probability (hemoglobin level under 12 mg/dl). Patients with a complete response to chemotherapy had a 100% survival compared to 93.1% and 53.8% for patients with responses > or =50% and <50% respectively (P = 0.0001). Patients with a pretreatment hemoglobin level of > or =12 mg/dl showed a survival of 87% compared to 63% for patients with a lower hemoglobin level (P = 0.008). CONCLUSIONS: Pretreatment Hb level showed a prognostic and independent predictive value for response to neoadjuvant chemotherapy in locally advanced cervical cancer. In our preliminary report, performed on a limited sample, a threshold of 12 mg/dl seems to be helpful to distinguish between "optimal" and "non-optimal" response.

Analysis of Variance↗
PubMed2005

Hemoglobin levels and 30-day mortality in patients after myocardial infarction.

BACKGROUND: Anemia is an independent risk factor for cardiovascular (CV) outcomes in patients with coronary artery disease and heart failure. However, the effect of hemoglobin levels on short-term CV mortality in patients with acute myocardial infarction (MI) remains unclear. METHODS: In a retrospective study we analyzed 1841 consecutive patients admitted with the diagnosis of acute MI. The primary end-point of the study was 30-day mortality. Patients were categorized according to the hemoglobin level on admission (10 g/dl or less, or greater than 10 g/dl). RESULTS: The overall 30-day mortality was 10.3%. The mortality was 21.6% in patients with hemoglobin levels on admission < or =10 g/dl and 9.3% in patients with hemoglobin levels >10 g/dl (p<0.001). Multivariate logistic regression analysis showed, that lower hemoglobin concentration is an independent predictor of 30-day mortality, when adjusted for other risk factors (HR 1.76, CI 1.08-2.85; p=0.02). CONCLUSIONS: Lower levels of hemoglobin are associated with higher short-term mortality in patients with acute MI. Specific therapeutic strategies in anemic patients with MI should be further considered.

Aged↗