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PubMed2005

Seasonal variation of pretransfusion hemoglobin levels in patients with thalassemia major.

Patients with thalassemia major often report that they do not maintain their usual pretransfusion hemoglobin concentration during the summer season. We collected 3977 pretransfusion hemoglobin values, amount of blood transfused, and intertransfusion intervals for 94 patients with thalassemia major from 4 centers worldwide. We also assessed the hematocrits of blood donors, the hemoglobin content of units transfused in one center, and the local mean monthly temperatures during the periods of data collection. Pretransfusion hemoglobin levels were significantly lower during the summer in all centers except the one center where monthly temperatures have the least variation throughout the year. A similar relationship to temperature was observed for the hematocrits of blood donors and the hemoglobin content of donor units. This study confirms that pretransfusion hemoglobin levels in patients with thalassemia major are lower in the summertime. Possible mechanisms include expansion of plasma volume with resultant hemodilution in the patient and lower hemoglobin content in donor blood.

Adolescent↗
PubMed1993

A study of the hemoglobin levels in breast-fed infants in one village of Okinawa prefecture.

We investigated the prevalence of anemia and the hemoglobin levels in breast-fed infants. Three hundred and fifty-six healthy children with different feeding methods were studied longitudinally. The results showed that the prevalence of anemia was higher and the hemoglobin levels were lower in breast-fed infants compared with those in partially breast-fed or formula-fed infants at late infancy.

Anemia, Hypochromic↗
PubMed2001

Epoetin alfa therapy increases hemoglobin levels and improves quality of life in patients with cancer-related anemia who are not receiving chemotherapy and patients with anemia who are receiving chemotherapy.

PURPOSE: To evaluate efficacy, safety, and quality of life (QOL) changes with epoetin alfa therapy for anemia in patients with nonmyeloid malignancies. PATIENTS AND METHODS: Anemic cancer patients were enrolled onto this prospective, open-label study from 34 centers across Canada. The trial had two cohorts: patients who were and were not receiving chemotherapy during the 16-week study. All patients initially received epoetin alfa 150 IU/kg subcutaneously three times per week. The dose was doubled after 4 weeks for patients who did not experience sufficient response. RESULTS: Of the 183 patients enrolled in the nonchemotherapy cohort, statistically significant and clinically relevant improvements in QOL were observed with epoetin alfa therapy using both the FACT-An questionnaire and linear analog scale assessment. Hemoglobin levels increased significantly (P <.001; mean increase 2.5 g/dL from baseline to end of study) and these increases were positively correlated with improved QOL and change in Eastern Cooperative Oncology Group (ECOG) scores. There was a significant reduction in the percentage of patients who required blood transfusions. The 218 patients in the chemotherapy cohort also experienced significant improvements in QOL, decreased transfusion use, and increased hemoglobin levels that correlated with QOL improvements and change in ECOG scores. Epoetin alfa was well-tolerated in both cohorts. CONCLUSION: Epoetin alfa administered to patients with cancer-related anemia for up to 16 weeks resulted in significantly improved QOL, increased hemoglobin levels, and decreased transfusion use. These benefits were observed in cancer patients who were not receiving chemotherapy as well as those who were.

Aged↗
PubMed2002

Low hemoglobin levels in children with in idiopathic growth hormone deficiency.

Multiple lines of evidence have implicated the growth hormone (GH) axis in the regulation of erythropoiesis. To test the hypothesis that GH deficiency is associated with hematologic abnormalities, we analyzed pretreatment hemoglobin levels in 100 children with GH deficiency. Hemoglobin levels were decreased in children with GH deficiency compared with age-corrected norms.

Adolescent↗
PubMed2006

Hemoglobin level as a risk factor for lower respiratory tract infections.

OBJECTIVE: This prospective study was conducted to evaluate the role of hemoglobin level, as a risk factor for Lower Respiratory Tract Infections in children (LRTI). METHODS: 100 children who came to the outpatient department for LRTI were included in the study. Age and sex-matched 100 children, not having any respiratory illness, were taken as control. They were subjected to complete blood count (CBC),C-reactive protein estimation (CRP), Mantoux test and X-ray chest. Peripheral smear, serum ferritin and serum iron binding capacity were done for all anemic children. Results. Radiological evidence of pneumonia was present in 63 children(63%).Hyper inflated lungs were seen in 27 (27%). Mantoux was positive in 22 children (22%) of study group and none among control group. CRP > 6 mg/L was noted in 45 children (45%) of study group and 14 (14%) of control group. Seventy four of study group (74 %) and 33 of control group (33%) had anemia. Of the anemic children, 60 (60%) had iron deficiency,10 (10%) chronic inflammation and 4 (4%) had hemolytic anemia. These values were 30 (30%), 2 (2%) and 1 (1%)respectively for control group. Low hemoglobin level due to whatever etiology, was a risk factor (p=0.000). CONCLUSION: Anemic children were 5.75 times more susceptible to LRTI compared to the control group. Prevention of anemia, due to whatever etiology, will reduce the incidence of LRTI.

Adolescent↗
PubMed2007

EPO adjustments in patients with elevated hemoglobin levels: provider practice patterns compared with recommended practice guidelines.

BACKGROUND: This study investigates provider practices regarding recombinant human erythropoietin (rHuEPO) dose when patient hemoglobin levels exceeded National Kidney Foundation-Dialysis Outcomes Quality Initiative target levels and reached 13 g/dL or greater (>or=130 g/L). METHODS: The study population (N = 167,796) was hemodialysis patients prevalent on January 1, 2003, who were on renal replacement therapy at least 90 days with Medicare as primary payer and rHuEPO claims in 2 or more consecutive months. Patient characteristics were obtained from the Centers for Medicare & Medicaid Services (CMS) Medical Evidence Report, and comorbid conditions were determined from Medicare claims. Providers and rHuEPO claims were linked by using CMS-assigned provider numbers and the CMS Annual End-Stage Renal Disease Facility Survey. Between-provider differences in patient characteristics were examined by using chi-square test, and provider effect on appropriate response, by using logistic regression. RESULTS: DaVita's percentage of monthly claims for patients with hemoglobin levels of 13 g/dL or greater (>or=130 g/L; 16.7%) and mean monthly rHuEPO dose (54,299 units) were highest. Dialysis Clinic Inc's percentage of such claims (2.0%) and mean monthly dose (38,687 units) were lowest. Dialysis Clinic Inc, Fresenius, and Renal Care Group had the highest percentage of recommended dose adjustments (mean, 70% of units); hospital-based units had the lowest (59%). By adjusted odds ratio, adjustments were 20% more likely for Dialysis Clinic Inc, Fresenius, and Renal Care Group compared with DaVita, National Nephrology Associates, hospital-based units, and independents (17% to 28% less likely). CONCLUSION: rHuEPO dose reduction practices are dependent on specific dialysis providers and whether units are hospital based or independent.

Adolescent↗
PubMed1991

Comparison of an isoelectric focusing technique and high-performance liquid chromatography for determination of fetal hemoglobin levels.

The authors previously have reported measurements of fetal hemoglobin in infants in blood samples taken at autopsy using an isoelectric focusing (IEF) procedure. The current study was undertaken to compare this methodology with a high-performance liquid chromatography (HPLC) procedure. The correlation coefficient between the IEF and HPLC procedures was 0.938. The HPLC method is technically easier and has fewer disadvantages than the IEF procedure and is recommended for the determination of fetal hemoglobin levels.

Chromatography, High Pressure Liquid↗
PubMed2006

Darbepoetin alfa administration to achieve and maintain target hemoglobin levels for 1 year in patients with chronic kidney disease.

OBJECTIVE: To assess the efficacy and safety of every-other-week darbepoetin alfa therapy in treating anemia and maintaining hemoglobin levels for 1 year in patients with chronic kidney disease (CKD) who were not undergoing dialysis and who had not previously received erythropolesis-stimulating proteins (ESPs). PATIENTS AND METHODS: This multicenter 52-week study (evaluation period, weeks 20-32), a subanalysis of the Simplify the Treatment of Anemia with Aranesp study, enrolled patients with CKD who were not receiving dialysis (creatinine clearance < or =70 mL/min or estimated glomerular filtration rate [GFR] < or =60 mL/min). Patients evaluated in this analysis were not receiving ESPs, had hemoglobin concentrations less than 11 g/dL, and had transferrin saturation of 20% or higher during screening. Patients Initiated every-other-week darbepoetin alfa therapy at 0.75 microg/kg, with the dose subsequently titrated to maintain hemoglobin levels not to exceed 12 g/dL. The first study participant was enrolled on February 4, 2002, and the last participant completed the study on March 31, 2004. RESULTS: The analysis included 911 patients (mean [SD] age, 66.4 [14.2] years; 54.3% female; 55.3% white). The least squares mean evaluation hemoglobin concentration was 11.54 g/dL (95% confidence interval, 11.47-11.61 g/dL), and the change from baseline was 1.6 g/dL (95% confidence interval, 1.5-1.7 g/dL). The mean (SD) every-other-week darbepoetin alfa dose during evaluation was 44.5 (33.7) microg. Iron supplementation was administered to 573 patients (62.9%) during the study. Darbepoetin alfa was well tolerated throughout the study period. CONCLUSION: Darbepoetin alfa initiated every other week safely and effectively treated anemia and maintained hemoglobin for 1 year in patients with CKD who were not undergoing dialysis and who were not receiving prior ESP therapy.

Aged↗
PubMed2001

The effect of hemoglobin level on radiotherapy outcomes: the Canadian experience.

Studies have shown that hemoglobin (Hb) level is a prognostic factor for outcomes following definitive radiotherapy in patients with a variety of tumors. We conducted a retrospective study on patients with carcinoma of the cervix to evaluate the relationships among Hb level, response to radiation, and effect on local control and survival. Data from 3 years (1989, 1990, 1992) were collected at seven institutions across Canada from women who received definitive radiotherapy, > or = 3,500 cGy, for carcinoma of the uterine cervix. The collected data included Hb levels at presentation and during radiation treatment specific for the time course of anemia and blood transfusion practice, patient demographics, details of the treatment regimen, and outcomes. Of 630 patients reviewed, 605 were eligible and were included in the analyses; median follow-up was 41 months. Twenty-five percent of patients received blood transfusions, most frequently when Hb decreased to below 100 g/L. Baseline Hb > or = 120 g/L was shown on univariate analysis to be significant for higher rates of pelvic disease control and disease-free survival. On multivariate analysis, baseline Hb was not a significant prognostic factor, but average weekly nadir Hb (AWNH) levels during radiotherapy were shown to be significant, and second only in importance to tumor stage. Five-year survival rates were similar if AWNH levels were > or = 12 g/L, regardless of whether baseline Hb was lower than 120 g/L (70%) or > or = 120 g/L (74%); the difference in 5-year survival between patients with lower AWNH (< 120 g/L) and higher AWNH (> or = 120 g/L) was significant. Patients with higher AWNH had significantly lower rates of overall relapse, local recurrence, and distant metastases. A stepwise significant increase was noted in overall survival rate as AWNH levels increased, regardless of transfusion status. Hemoglobin levels > or = 120 g/L during radiotherapy were shown to be a significant prognostic factor for successful radiotherapy and disease-free survival. There was no difference in outcomes relative to transfusion status.

Anemia↗
PubMed2006

Normalization of hemoglobin level in patients with chronic kidney disease and anemia.

BACKGROUND: Whether correction of anemia in patients with stage 3 or 4 chronic kidney disease improves cardiovascular outcomes is not established. METHODS: We randomly assigned 603 patients with an estimated glomerular filtration rate (GFR) of 15.0 to 35.0 ml per minute per 1.73 m2 of body-surface area and mild-to-moderate anemia (hemoglobin level, 11.0 to 12.5 g per deciliter) to a target hemoglobin value in the normal range (13.0 to 15.0 g per deciliter, group 1) or the subnormal range (10.5 to 11.5 g per deciliter, group 2). Subcutaneous erythropoietin (epoetin beta) was initiated at randomization (group 1) or only after the hemoglobin level fell below 10.5 g per deciliter (group 2). The primary end point was a composite of eight cardiovascular events; secondary end points included left ventricular mass index, quality-of-life scores, and the progression of chronic kidney disease. RESULTS: During the 3-year study, complete correction of anemia did not affect the likelihood of a first cardiovascular event (58 events in group 1 vs. 47 events in group 2; hazard ratio, 0.78; 95% confidence interval, 0.53 to 1.14; P=0.20). Left ventricular mass index remained stable in both groups. The mean estimated GFR was 24.9 ml per minute in group 1 and 24.2 ml per minute in group 2 at baseline and decreased by 3.6 and 3.1 ml per minute per year, respectively (P=0.40). Dialysis was required in more patients in group 1 than in group 2 (127 vs. 111, P=0.03). General health and physical function improved significantly (P=0.003 and P<0.001, respectively, in group 1, as compared with group 2). There was no significant difference in the combined incidence of adverse events between the two groups, but hypertensive episodes and headaches were more prevalent in group 1. CONCLUSIONS: In patients with chronic kidney disease, early complete correction of anemia does not reduce the risk of cardiovascular events. (ClinicalTrials.gov number, NCT00321919 [ClinicalTrials.gov].).

Anemia↗
PubMed1980

Postpartum glycosylated hemoglobin levels in mothers of large--for--gestational age infants.

Glycosylated hemoglobin levels were determined in 19 women who were delivered of large--for--gestational age (greater than 4,082 grams) infants and compared to control values. Although the mean level for each group did not differ significantly (6.7% +/- 1.5% versus 6.5% +/- 0.2%) three women had increased hemoglobin glycosylation. In this series the birth of a large infant correlated with prepregnancy obesity and greater weight gain during pregnancy.

Birth Weight↗
PubMed1997

The relationship between maternal weight gain in pregnancy, hemoglobin level, stature, antenatal attendance and low birth weight.

Low birth weight (birth weight less 2,500 g) remains a major public health problem in many communities. Five hundred and twenty-eight (528) consecutive singleton maternities delivered at the Armed Forces Hospital Tabuk, northwest Saudi Arabia were studied to identify the relationship between prenatal weight gain, maternal hemoglobin at delivery, maternal stature, antenatal clinic attendance and low birth weight (LBW). Of the total number, 9.5% (50/528) babies were of low birth weight, 56% of which were preterm while 44% were term and small for gestational age, resembling the pattern observed in developed countries rather than developing countries. Mothers who delivered LBW babies gained significantly less weight in the 3rd trimester and last 4 weeks of term pregnancy when compared with controls who had normal weight babies (NW > or = 2,500 g) who were delivered in the study period (t = 4.06, p < 0.0001, t = 3.7, p < 0.001). There was no significant difference in the prenatal weight gain in the second trimester for the two groups of mothers (p = 0.53). Mothers with LBW babies also had significantly lower Body Mass Index (BMI) at onset of pregnancy (t = 3.8, p = 0.001) and were shorter in height (t = 2.12, p < 0.03). Mothers who delivered preterm LBW babies had significantly lower hemoglobin levels at delivery when compared with those who had NW deliveries (p < 0.002). There was no difference in hemoglobin levels of mothers who had LBW babies at term and those with NW at term (p = 0.72). For this community, it is suggested that to reduce the LBW baby rate and improve birth weight, anemia must be prevented in pregnancy; attention needs to be paid to weight gained in the third trimester and the last 4 weeks of pregnancy encouraging antenatal clinic attendance, and improving the nutritional status of female children so that optimal height is achieved by the age of reproduction.

Birth Weight↗
PubMed2004

Hemoglobin level is an independent predictor for adverse cardiovascular outcomes in women undergoing evaluation for chest pain: results from the National Heart, Lung, and Blood Institute Women's Ischemia Syndrome Evaluation Study.

OBJECTIVES: This study was designed to investigate the relationship between hemoglobin level (Hgb) and adverse cardiovascular outcomes in women with suspected ischemia. BACKGROUND: Low Hgb levels correlate with increased cardiovascular morbidity and mortality in patients presenting with acute myocardial infarction (MI) or congestive heart failure (CHF). However, the prognostic significance of Hgb in women with suspected ischemia is unclear. METHODS: As part of the National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women's Ischemia Syndrome Evaluation (WISE), we prospectively studied 936 women referred for coronary angiography to evaluate suspected ischemia. We compared Hgb levels with cardiovascular risk factors, core lab interpreted angiograms, inflammatory markers, and adverse cardiovascular outcomes. RESULTS: Of women enrolled, 864 (mean age 58.4 +/-11.6 years) had complete Hgb, angiogram, and follow-up (mean 3.3 +/- 1.7 years) data. The mean Hgb was 12.9 g/dl (range 7.7 to 16.4 g/dl) and 184 women (21%) were anemic (Hgb <12 g/dl). Anemic women had higher creatinine and were more likely to be nonwhite and have a history of diabetes, hypertension, and CHF (p < 0.05). However, we found no difference in EF or severity of coronary artery disease. Anemic women had a higher risk of death from any cause (10.3% vs. 5.4%; p = 0.02) and total adverse outcomes (26% vs. 16%, p < 0.01). In a multivariable model, decreasing Hgb was associated with significantly higher risk of adverse outcomes (hazard ratio = 1.20, p = 0.002). Also, anemic women had shorter survival time free of adverse outcome (p < 0.001). CONCLUSIONS: Our findings extend previous reports, linking lower hemoglobin levels with higher risk for adverse cardiovascular outcomes, to women evaluated for suspected ischemia in the absence of acute MI or CHF.

Adolescent↗
PubMedDate not supplied

Adjuvant radiotherapy in carcinomas of the uterine cervix: the prognostic value of hemoglobin levels.

Anemia has been associated with a poorer treatment response and reduced survival in women undergoing primary radiotherapy (RT) or radiochemotherapy for advanced cervical carcinoma. This study aimed to determine the influence of anemia on outcome in patients with cervical carcinoma undergoing adjuvant RT. Medical records were reviewed for 183 cervical cancer patients who had received adjuvant RT because of risk factors after radical surgery (n= 109) or inadequate primary surgery (simple hysterectomy; n= 74). Kaplan-Meier and Cox regression analyses were used to study hemoglobin levels before and during adjuvant RT in relation to recurrence-free and overall survival. Hemoglobin values > or =11 g/dL were considered normal, while those <11 g/dL indicated anemia. Hemoglobin levels before RT influenced significantly overall survival and recurrence-free survival across the whole group (overall survival--log rank(all patients)= 7.5; df = 1; P= 0.006). However, subgroup analysis showed that the observed difference was mainly due to the group of women who had undergone inadequate primary surgery (overall survival--log rank(inadequate surgery)= 10.8; df = 1; P= 0.001). Multifactorial regression analyses comparing hemoglobin before RT with grading and tumor stage confirmed the prognostic value of hemoglobin values. Maintaining normal hemoglobin values before and during adjuvant RT seems to be important, especially in patients who have had inappropriate simple hysterectomy, which may resemble a therapeutic situation.

Adult↗
PubMed1988

Glycated albumin and glycated hemoglobin levels in normal pregnancy.

Glycated albumin levels showed a progressive increase during normal pregnancy. The mean values (mole hexose/mole protein) were 1.68 +/- 0.27 (n = 15) in nonpregnant women, 1.83 +/- 0.21 (n = 11) in first trimester, 2.00 +/- 0.41 (n = 13) in second trimester, and 2.42 +/- 0.49 (n = 15) in third trimester. Glycated hemoglobin levels indicated a biphase pattern with low values at midpregnancy (controls 0.29 +/- 0.05, first trimester 0.30 +/- 0.04, second trimester 0.27 +/- 0.05, and third trimester 0.33 +/- 0.04). The data suggest that glycated albumin reflects the decreased glucose tolerance in pregnancy better that glycated hemoglobin levels. The reasons for the differing pattern of the two glycated proteins are discussed.

Adult↗
PubMed1994

Relationship of burst-forming-unit-erythroid progenitors and their DNA-synthesis stage to fetal hemoglobin levels in hydroxyurea-treated patients with sickle cell anemia.

DNA-synthesis stage and total number of circulating burst-forming-units-erythroid (BFU-E) have been inversely correlated with hemoglobin F levels in the peripheral blood, as well as in the cells from the BFU-E-derived colonies obtained from homozygous sickle cell anemia (SS) patients during steady state. Similar studies in SS patients treated with cytotoxic agents have not been reported. However, regeneration of the erythroid marrow that follows the cytoreduction phase of chemotherapy has been suggested as one of the mechanisms of stimulation of fetal hemoglobin synthesis. Therefore, a longitudinal study of hemopoiesis in hydroxyurea-treated SS patients was conducted. Thirty-two sets of hemopoietic studies, including total circulating BFU-E and S-phase BFU-E, were obtained from three patients treated with hydroxyurea. A dose-dependent decrease in total BFU-E colonies occurred in peripheral blood of all three patients (r = -0.58, -0.85, and -0.97, respectively, with each P < 0.05). There was a strong positive correlation between hydroxyurea dose and fetal hemoglobin levels in two of the three patients who responded clinically (r = 0.89618 and 0.88632, respectively, with each P < 0.01). When data from all patients were combined (n = 32), there was a strong, inverse, linear relationship between total number of BFU-E and percentage S-phase BFU-E with fetal hemoglobin levels (r = -0.6649 and -0.7404, respectively, with each P < 0.0001). A stronger, curvilinear, multiple relationship was detected between total BFU-E and percentage S-phase BFU-E with fetal hemoglobin levels (R = 0.8351 and 0.8602 with each P < 0.0001).

Adolescent↗
PubMed2003

[The connection between vitamin and antioxidant status of the children with decreased hemoglobin level].

The investigation of vitamin sufficiency of 96 children 4-15 years old living in Moscow with decreased hemoglobin level (less 120 g/l) has been carried out in spring in 2001. Most of the children (90 per cent) had the combined deficiency of B group vitamins and carotenoids while they were sufficiently vitamin C supplied. There were only 2 per cent of children adequately supplied with all vitamins. Range correlation between hemoglobin blood level and riboflavin and tocopherols serum concentration has been observed. Marked negative linear correlation between riboflavin and malone dialdehyde serum content has been revealed: more sufficiently supplied with vitamin B2 child has lower lipid oxidative product level. Thus the necessity of vitamin B2 including in complex therapy of iron deficiency is based.

Adolescent↗