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PubMed1995

Hemoglobin levels during twin vs. singleton pregnancies. Parity makes the difference.

A retrospective, case-control study of 200 consecutive twin and singleton gestations matched for parity was conducted to challenge the hypothesis that lower hemoglobin values appear more often during twin gestations. The database consisted of hemoglobin levels recorded during each trimester. Comparisons were made between the mean hemoglobin levels and incidence of values > 11, 9-11 and < 9 g/dL. Significantly lower mean (+/- SD) hemoglobin values were observed during the first (11.94 +/- 1.1 vs. 12.17 +/- 1.0, P = .026) and second (11.1 +/- 1.0 vs. 11.48 +/- 0.9, P = .00001) trimesters in twin vs. singleton pregnancies, respectively. The differences resulted from lower values in multiparas with twins as compared with their singleton-pregnancy controls (11.8 +/- 1.2 vs. 12.2 +/- 0.9, P = .015, for the first trimester and 11.0 +/- 1.0 vs. 11.5 +/- 0.9, P = .0001, for the second trimester). During the second trimester, the lower incidence of values > 11 g/dL (P = .005, odds ratio = .475, 95% confidence interval = .31-.73) and higher incidence of values between 9 and 11 g/dL (P = .0008, odds ratio = 2.06, 95% confidence interval = 1.34-3.19) may account for the significant differences in mean values. There were no differences between third-trimester values, between nulliparas in both groups or between nulliparas and multiparas in each group. We conclude that the lower hemoglobin levels in twin gestations were associated with multiparity and were statistically significant during the first and second trimesters. This subgroup of twin pregnancies may benefit from further research and possibly from closer hematologic care and monitored iron supplementation.

Adult↗
PubMed2004

Relationship of hemoglobin levels to fatigue and cognitive functioning among cancer patients receiving chemotherapy.

The aim of this study was to examine the relationship of changes in hemoglobin levels to changes in fatigue and cognitive functioning in cancer patients undergoing chemotherapy treatment. Seventy-seven (77) patients completed a self-administered measure of fatigue and a battery of psychometrician-administered measures of cognitive performance before the start of chemotherapy and again before the start of the fourth treatment cycle. Hemoglobin levels were measured at corresponding timepoints. Findings partially supported the hypothesis that greater declines in hemoglobin over the course of repeated chemotherapy administrations would be accompanied by greater increases in fatigue and greater declines in cognitive performance over the same interval. Among the subset of 49 patients who demonstrated a decline in hemoglobin to a final value < or =12 g/dL, greater declines in hemoglobin were significantly (P<0.05) related to greater increases in fatigue duration and disruptiveness and more negative changes in performance on three cognitive tasks. These findings suggest that, in addition to previously reported relationships with fatigue, declines in hemoglobin levels during chemotherapy treatment are associated with adverse changes in cognitive functioning.

Adult↗
PubMed2001

The impact of hemoglobin levels on treatment outcomes in patients with cancer.

Clinical trials and surveys have shown that a majority of patients with cancer have low hemoglobin levels as a result of the disease and/or treatment. Clinical trials also have shown that the impact of anemia may be more insidious and far-reaching than generally appreciated. Specifically, studies have shown that low hemoglobin levels have significant impact on treatment outcomes, including survival. The mechanisms by which treatment efficacy and survival are compromised have not been fully elucidated but may include cellular compromise (eg, impaired tumor oxygenation), or more general patient compromise (eg, decreased quality of life and treatment delivery). Recent studies have suggested that increasing hemoglobin levels with recombinant human erythropoietin (r-HuEPO, epoetin alfa) have resulted in better outcomes following radiotherapy, chemotherapy, and the combined-treatment modality.

Anemia↗
PubMed1989

Single dose metrifonate or praziquantel treatment in Kenyan children. I. Effects on Schistosoma haematobium, hookworm, hemoglobin levels, splenomegaly, and hepatomegaly.

The relationships between S. haematobium, hookworm, malaria, hemoglobin level, splenomegaly, and hepatomegaly before and 8 months after treatment with a single dose of metrifonate or praziquantel were studied in Kenyan primary schoolchildren in an area where anemia, S. haematobium, and hookworm are common and malaria is holoendemic. Children with light to moderate S. haematobium infection were examined (Exam 1), assigned at random to groups receiving placebo (PL, n = 104), metrifonate (MT, n = 103, dose 10 mg/kg body weight) or praziquantel (PR, n = 105, dose 40 mg/kg body weight), treated, and examined 8 months later (Exam 2). At Exam 2, 62% of the MT group still passed S. haematobium eggs vs. 13% in the PR group. Egg reduction rates were substantial in both groups, but greater in the PR group; geometric mean egg counts in both groups were very low. Prevalence and intensity in the PL group had not changed between exams. Hookworm egg counts were significantly reduced in the MT group (59% egg reduction rate); malarial infection had increased in all 3 groups, presumably due to the long rainy season between exams. Hookworm egg count was the most significant predictor of initial hemoglobin level, followed by S. haematobium egg count and presence of malarial infection. Treatment with a single dose of MT or PR can produce substantial decreases in S. haematobium infection 8 months later.

Adolescent↗
PubMed1986

Effect of obesity on erythrocyte count and hemoglobin levels in Libyan diabetic patients.

Fasting blood glucose, erythrocyte count and hemoglobin levels of obese and nonobese Libyan diabetic women were determined. The mean values of fasting blood glucose, erythrocyte count and hemoglobin of obese diabetic women were 209.55 +/- 8.85 mg/dl, 4.986 +/- 0.04 X 10(6)/mm3 and 14.51 +/- 0.18 g/dl. The respective values for nonobese diabetic women were 243.47 +/- 12.56 mg/dl, 4.865 +/- 0.06 X 10(6)/mm3 and 14.31 +/- 0.19 g/dl. The mean values of the three variables of obese patients were significantly different from those of the nonobese patients. Statistically significant correlations were found between fasting blood glucose levels and erythrocyte count, and hemoglobin levels in both obese and nonobese patients. The levels of erythrocyte count and hemoglobin of obese patients were higher than those of their nonobese counterparts. This elevation was attributed to the effect of obesity. It is suggested that regulation of body weight should be considered an essential step in the management of diabetes.

Blood Glucose↗
PubMed1998

The causes and prognostic significance of low hemoglobin levels in tumor patients.

BACKGROUND: While the production and degradation of erythrocytes are carefully balanced in healthy persons several processes can lead to an imbalance in tumor patients resulting in anemia. PATHOGENESIS: Processes caused by the tumor itself can lead to a typical "anemia of chronic disease" which is normochromic, normocytic, accompanied by both a reduced number of reticulocytes and reduced iron-binding capacity. In many cases, the erythropoietin response to anemia is insufficient. Cytokines such as interleukin-1, interleukin-6, and tumor necrosis factor seem to be involved in suppressing erythropoiesis by acting on the bone marrow and on erythropoietin production. Anemia can also be the result of cancer therapy, as is particularly prominent in patients with lung cancer receiving chemotherapy (incidence of anemia 20 to 50%). PROGNOSTIC FACTOR: Several studies have demonstrated that anemia is not only linked to an impaired quality of life but to prognosis as well. Albain et al. [2] identified a hemoglobin level of below 11 g/dl as a significant independent prognostic factor associated with shorter survival of chemotherapeutically treated non-small cell lung cancer (NSCLC) patients. The same applies to a hemoglobin level below 12.7 g/dl for radiotherapeutically treated NSCLC patients according to a study by Ohlhauser et al. (Oncology 1997;20:1689-92). Several studies have confirmed this prognostic importance of hemoglobin level for other solid tumors. TREATMENT: To correct anemia, clinicians have several options. Given the risks associated with transfusions, especially for tumor patients, recombinant erythropoietin holds promise for raising hemoglobin levels and thereby improving therapeutic efficacy and survival.

Anemia↗
PubMed2003

The effects of higher hemoglobin levels on mortality and hospitalization in hemodialysis patients.

BACKGROUND: The introduction of recombinant human erythropoietin for the treatment of anemia of chronic renal failure provided the opportunity to correct anemia in this patient population. The optimal target hemoglobin for patients with end-stage renal disease (ESRD) remains controversial. A large database of hemodialysis patients was analyzed to determine whether increasing hemoglobin level above the current Kidney Dialysis Outcomes Quality Initiative (K/DOQI) recommendations was associated with increased risk of mortality and hospitalization. METHODS: A longitudinal study of hemodialysis patients in Fresenius Medical Care-North America facilities was performed. Selection was restricted to patients in the census for 6 consecutive months from July 1, 1998 through June 30, 2000. Patient mean hemoglobin and other covariates measured during the initial 6 months were related to survival, number of hospitalizations, and length of stay over the subsequent 6 months of follow-up. RESULTS: Patients with hemoglobin <9 g/dL had an adjusted relative risk of death of 2.11 compared to those patients with 11 </= hemoglobin < 12 g/dL (P < 0.0001). The adjusted relative risk of death was 0.84 for 12 </= hemoglobin < 13 g/dL (P = 0.007). These data suggest there is no increased risk of mortality associated with hemoglobin above the current recommended values. Both number of hospitalizations and length of stay decreased as hemoglobin increased. Patients with hemoglobin >/=13 g/dL had an adjusted length of stay of 9.6 days compared to 10.9 days for those with 11 </= hemoglobin < 12 g/dL (P < 0.0001). CONCLUSION: These data indicate the relative risk of death and hospitalization are inversely associated with hemoglobin levels, with no apparent additional risk associated with hemoglobin levels> 12 g/dL.

Adult↗
PubMed1993

First- and second-trimester hemoglobin levels. Relation to birth weight and gestational age.

The computerized records of 3074 women who were delivered during the period 1987-1990 were analysed. We studied possible relations of birth weight and gestational age to maternal first- and second-trimester hemoglobin levels. Birth weight and gestational age were taken as outcome variables in a multiple stepwise regression analysis, including factors that might interact with hemoglobin levels. A strong independent inverse correlation between the lowest second-trimester hemoglobin and birth weight was observed. First-trimester hemoglobin levels explained little with regard to birth weight, but had a small negative correlation to gestational age. For gestational age < 259 days we found a strong positive correlation between the first- to second-trimester decrease in hemoglobin and birth weight.

Birth Weight↗
PubMed2005

Increased hemoglobin levels and improved quality-of-life assessments during epoetin alfa treatment in anemic cancer patients: results of a prospective, multicenter German trial.

This prospective, open-label, multicenter study was undertaken to determine the safety and efficacy of epoetin alfa in increasing hemoglobin levels and improving quality of life (QOL), specifically fatigue, in cancer patients receiving chemotherapy with or without radiotherapy (n=702). Epoetin alfa, 10,000 IU three times a week s.c. for 8-18 weeks, increased the mean hemoglobin level relative to baseline (1.0 +/- 1.5 g/dl by week 4 and > or =1.7 g/dl from week 10 through the end of the trial), with 63.4% of patients experiencing > or =2 g/dl increases in hemoglobin above baseline at some time during the study. Fatigue is an important component of QOL. Physicians, nurses, and patients independently assessed patient fatigue level on a linear-analogue scale. Although all three groups reported improvements in patient fatigue over the course of the study (p <.0001), the magnitude of fatigue ratings and their relationship to tumor response and to hemoglobin level varied by group. Overall, epoetin alfa was well tolerated and effective in improving hemoglobin levels and decreasing fatigue in patients undergoing chemotherapy.

Adult↗
PubMed2003

Antioxidant vitamins improves hemoglobin level in children with group a beta hemolytic streptococcal infection.

A study was done on school children infected with group A beta hemolytic streptococci to examine whether antioxidant vitamins play a role in improving the hemoglobin level. A total of 606 primary school children aged 5 to 15 years were randomly divided into two intervention groups. Group 1 (n=299) was treated with pehnoxymethyl penicillin V and group 2 (n=307) was treated with phenoxymethyl penicillin V plus antioxidant vitamins for eight weeks. From each group two blood samples were drawn in acute and convalescent (after eight weeks) states. Before treatment, mean hemoglobin values were 11.0 and 10.8 mg/dL in groups 1 and 2 respectively. After treatment hemoglobin values were 10.5 and 11.6 mg/dL respectively. Values were significantly decreased in group 1 (P=0.0001), whereas increased in group 2 (P=0.001). Adjustment for age and sex by ANCOVA confirmed the difference in hemoglobin levels between group (LS means-0.5 vs 0.8 in groups 1 and 2 respectively (P=0.0001). Hemoglobin level increases after antioxidant vitamin supplementation in children suffering from group A beta hemolytic streptococcal infection.

Adolescent↗
PubMed2004

[Changes in serum Na+ and blood hemoglobin levels during three types of transurethral procedures for the treatment of benign prostatic hypertrophy].

BACKGROUND: Transurethral holmium YAG laser resection of the prostate (HoLR-P) and transurethral electrovaporization of the prostate (TUV-P) have recently received increasing attention as an effective minimally invasive approach for the treatment of prostatic hypertrophy. However, less information is available regarding the intraoperative changes in the serum Na+ and blood hemoglobin levels during either HoLR-P or TUV-P. METHODS: Intraoperative changes in serum Na+ and blood hemoglobin levels were investigated in 17 patients undergoing transurethral resection of the prostate (TUR-P, n = 7), HoLR-P (n = 7) or TUV-P (n = 3). The 3% D-sorbitol solution was used as the irrigating fluid in all the patients. RESULTS: In three patients, severe hyponatremia (118-123 mEq x l(-1)) developed abruptly (< or = 15 min) at various time points during TUR-P with (n = 1) or without (n = 2) cystostomy. However, no clinical symptoms were observed after development of the hyponatremia in those awake patients. No large (> 10 mEq x l(-1)) decreases in the Na+ level were observed in any of the patients undergoing HoLR-P or TUV-P. In patients undergoing TUR-P and HoLR-P, percent changes in serum Na+ level significantly correlated with those in blood hemoglobin level, but not with the resection time; the slopes were significantly larger than unity. CONCLUSIONS: The TUR syndrome is less likely to occur during HoLR-P or TUV-P. During TUR-P, the onset of severe hyponatremia appears to be unpredictable, and may not necessarily be accompanied by clinical symptoms. Frequent measurements of the serum Na+ level appear essential for early detection of severe hyponatremia.

Aged↗
PubMed2005

Epoetin alfa 40000 U once weekly and intravenous iron supply in solid tumor patients: early increase of hemoglobin level during chemotherapy.

The objective of this observational study was the early evaluation of the impact, a week after the first administration of epoetin alfa 40000 U once weekly and i.v. dose of 62.5 mg sodium ferric gluconate for seven days in improving hemoglobin levels in cancer patients affected by mild/moderate or severe anemia during chemotherapy. Twenty patients affected by solid tumors who received epoetin alfa 40000 U once weekly and daily i.v. sodium ferric gluconate for one week were evaluated: 90% of the patients showed hemoglobin increase, with a median level of hemoglobin increase of 0.73 g/L from baseline, and 50% of them showing a hemoglobin increase > 1 gr/L. The treatment was well tolerated and no adverse event was observed. The early increase of hemoglobin level from baseline is interesting and suggestive for the possibility of achieving an adequate hemoglobin level with a short-term treatment. It is still necessary to further explore the real need of iron supplementation to maintain adequate erythropoiesis prior and during epoetin therapy.

Adult↗
PubMed2004

Blood hemoglobin level and treatment outcome of early breast cancer.

BACKGROUND AND PURPOSE: To determine whether the blood hemoglobin concentration correlates with the prognosis of patients with early breast cancer and, if so, whether this is restricted to treatment modality. PATIENTS AND METHODS: Data were collected retrospectively from patients with early breast cancer (T1,2 N0-2 M0) who underwent either breast-conserving surgery followed by adjuvant radiotherapy (BCS-RT; n=96) or a modified radical mastectomy (MRM; n=194). The effect of preoperative blood hemoglobin level, nodal status, histological grading and hormone receptor status on disease-free survival was determined for both treatment modalities using a Cox regression model and visualized by Kaplan-Meier plots. RESULTS: The blood hemoglobin concentration significantly correlated with disease-free survival of patients receiving BCS-RT (relative risk [RR]: 0.67 per g/dl; p=0.007). This was independent of other known risk factors for breast cancer patients, as determined by multivariate analysis. By contrast, the blood hemoglobin level had no prognostic significance when patients were treated with MRM. CONCLUSION: Blood hemoglobin concentration seems to affect the prognosis of patients with early breast cancer when a treatment schedule that includes radiotherapy is applied. Reduced radiosensitivity due to diminished tumor oxygenation may be the underlying cause. Confirmative trials and studies intended to elucidate the underlying mechanism are warranted.

Adult↗
PubMed2002

Relationship between changes in hemoglobin level and quality of life during chemotherapy in anemic cancer patients receiving epoetin alfa therapy.

BACKGROUND: Hemoglobin increases have been associated with quality of life (QOL) improvements in anemic cancer patients treated with epoetin alfa, but intervention generally has been reserved for symptomatic anemia or hemoglobin < 10 g/dL. Relationships among hemoglobin, functional status, and patient reported QOL have not been well characterized. METHODS: Data from two open-label, community-based trials of epoetin alfa therapy that enrolled 4382 anemic cancer patients undergoing chemotherapy were used to evaluate the relationship between hemoglobin changes and QOL changes. The authors measured QOL using the Linear Analog Scale Assessment (LASA) and the more detailed, disease-specific Functional Assessment of Cancer Therapy-Anemia (FACT-An) instrument. Analyses were performed to determine the incremental change in QOL associated with hemoglobin increases (1 g/dL increments). RESULTS: Cross-sectional analyses showed a nonlinear relationship and significant positive correlation between high hemoglobin levels and high LASA and FACT-An scores (r = 0.25 and 0.29, respectively, P < 0.01). Patients with hemoglobin increases of > or = 2 g/dL reported statistically significant improvements in five FACT-An items selected a priori specifically to reflect functional capacity. An incremental analysis used regression methods to identify the longitudinal relationship between incremental changes in hemoglobin and QOL scores. This relationship was found to be nonlinear, with the maximum QOL gain occurring at a hemoglobin level of 12 g/dL (range, 11-13 g/dL). Patients with low baseline QOL scores and longer time periods between baseline and final QOL assessments experienced significantly (P < 0.05) greater increases in overall QOL. Progressive disease at baseline, change in disease status from baseline to end of study, and increase in self-reported pain or nausea all had significant (P < 0.05) negative effects on QOL scores. CONCLUSIONS: A direct relationship exists between hemoglobin increases during epoetin alfa therapy and corresponding QOL improvements in cancer patients receiving chemotherapy across the clinically relevant hemoglobin range of 8-14 g/dL. These data suggest that the maximal incremental gain in QOL occurs when hemoglobin is in the range of 11-13 g/dL.

Anemia↗
PubMed2005

The effect of nandrolone decanoate on bone mineral density, muscle mass, and hemoglobin levels in elderly women with osteoporosis: a double-blind, randomized, placebo-controlled clinical trial.

METHODS: In a randomized, double-blind, placebo-controlled clinical trial, we evaluated the effect of a 2-year treatment with nandrolone decanoate (ND) on bone mineral density (BMD) of lumbar spine, femoral neck, and trochanter and on vertebral fracture rate, muscle mass, and hemoglobin levels. Sixty-five osteoporotic women older than 70 years were studied. Thirty-two patients received injections of 50 mg ND, and 33 received placebos every 3 weeks. All patients received 500 mg calcium tablets daily. RESULTS: Compared to baseline, ND increased the BMD of the lumbar spine (3.4% +/- 6.0 and 3.7% +/- 7.4; p < .05) and femoral neck (4.1% +/- 7.3 and 4.7% +/- 8.0; p < .05) after 1 and 2 years, respectively. The BMD of trochanter increased significantly only after the first year (4.8% +/- 9.3, p < .05). Compared to the placebo group, the ND group presented with significantly increased BMD of the trochanter and neck. ND significantly reduced incidence of new vertebral fractures (21% vs 43% in the placebo group; p < .05). ND showed a significant statistical increase in lean body mass after the first (6.2% +/- 5.8; p < .01) and second years (11.9% +/- 29.2; p < .01). In addition, a 2-year treatment with ND significantly increased hemoglobin levels compared to baseline (14.3%; p < .01) and placebo (p < .01). CONCLUSIONS: ND increased BMD, hemoglobin levels, and muscle mass, and reduced the vertebral fracture rate of elderly osteoporotic women.

Absorptiometry, Photon↗
PubMed2000

Blood hemoglobin level may affect radiosensitivity-preliminary results on acutely reacting normal tissues.

PURPOSE: To evaluate the influence of blood hemoglobin concentration on the radiosensitivity of acutely reacting normal tissues. METHODS AND MATERIALS: Weekly scores (EORTC/RTOG criteria) for acute reactions of skin and mucosa are available for 60 patients with cancer of the head and neck undergoing a standard conventional radiotherapy. The prognostic significance of blood hemoglobin levels on the development of acute reactions is studied by multivariate analysis (Cox Proportional Hazards Model). Further, the incidence and the time to development of these reactions is looked at in cohorts of patients with different mean blood hemoglobin concentrations during radiotherapy. Patients are therefore classified into a "severely anemic group" (hemoglobin < 11.0 g/100 mL), and into a cohort with a blood hemoglobin value equal or above 11.0 g/100 mL. RESULTS: Normal tissue scoring and monitoring of blood hemoglobin levels allows for a detailed analysis of possible correlations. A decrease in the mean blood hemoglobin value of 1 g/100 mL predicts a reduced risk to develop a skin reaction of Grade 2 or 3 (RR = 0.9; p = 0.08; RR = 0.8; p = 0.26, respectively) or a mucosa reaction of Grade 3 (RR = 0.8; p = 0.16), independent from the radiation dose, the treatment time and from previous surgery within the radiation volume (multivariate analysis). Likewise, patients with severe anemia develop grade 3 mucositis or dermatitis less often (0%; 13%) as compared to those with blood hemoglobin concentrations equal or above 11.0 g/100 mL (21%; 19%). Skin and mucosa reactions further tend to occur later in the course of radiation. The observations are not statistically significant and possible reasons will be discussed. CONCLUSIONS: A decreased blood hemoglobin concentration may-perhaps by an impaired tissue oxygenation-reduce the radiosensitivity of normal tissue such as skin and mucosa. However, the data is preliminary and needs further confirmation.

Adult↗
PubMed1995

[The effect of the use of milk fortified with iron and vitamin C on hemoglobin levels and nutritional status of children under 2].

The impact of the use of fortified powdered whole milk (9 mg of iron and 65 mg of vitamin C/100 g of milk) on the hemoglobin levels of children under 2 years of age was evaluated, over a period of 6 months, in 107 children enrolled in municipal Day Care Centers (DCC) and in 228 seen at a Basic Health Care Unit (BHCU). Before the beginning of the intervention, 66.4% of the children in the DCC and 72.8% of those seen at the BHCU had hemoglobin levels under 11.0 g/dl. After 6 months of fortified milk intake, these percentages fell to 20.6% and 18.0% respectively. The average hemoglobin before the intervention was 10.3 g/dl in the DCC and 10.5 in the BHCU. After 6 months these increased to 11.6 g/dl in the populations studied. Concerning the nutritional condition, evaluated according to Gomez's criteria, 57% of the DCC children presented an improvement, 41.1% showed changes and only 1.9% became worse. In the BHCU, 11.4% presented better condition, 70.6% remained the same and 18% worsened, which demonstrated differences in response regarding improvement of nutritional condition, when fortified milk was used in closed and open environments. The authors conclude that the utilization of enriched foods is an excellent alternative in the treatment of iron deficiency in populations of children under 2 years of age.

Ambulatory Care Facilities↗
PubMed1971

Hemoglobin levels and iron intakes of infants attending selected child health centres in the city of Toronto.

An investigation of the hemoglobin levels of infants in potentially high-risk categories demonstrated the possibilities of a public health program of screening and referral for anemia. Blood samples for hemoglobin determinations and particulars of 24-hour dietary intakes were obtained for 252 infants between the ages of 6 and 18 months at seven child health centres in the City of Toronto. Twenty-nine percent of the infants had hemoglobin levels below 10 g./100 ml. of blood. Problems in the collection and analysis of dietary data limited the interpretation of iron intakes.

Age Factors↗