The role of bone marrow(BM)compensatory response in autoimmune hemolytic anemias(AIHAs)is emerging and inadequate reticulocytosis has been associated with more severe disease and adverse outcomes.However,few is known ...The role of bone marrow(BM)compensatory response in autoimmune hemolytic anemias(AIHAs)is emerging and inadequate reticulocytosis has been associated with more severe disease and adverse outcomes.However,few is known about the BM immunologic microenvironment composition in these diseases.Here we investigated BM features in a large cohort of 97 patients with autoimmune hemolytic anemia(AIHA)and observed a high prevalence of hypercellularity,dyserythropoiesis,reticulin fibrosis,and T-cell infiltration(65%,29%,76%,and 69%of patients,respectively).These findings were associated with inadequate bone marrow compensation,more severe anemia at onset,and need of multiple treatments.In a subset of warm type AIHA patients we investigated BM microenvironment by single-cell RNA sequencing.We found distinct immune cell profiles across disease stages(diagnosis,remission,relapse).In particular,upregulation of inflammatory response pathways was noted in CD8+,CD4+,and monocyte subsets during relapse compared to diagnosis and remission.Moreover,by single-cell TCR sequencing,we found small T cell clones at diagnosis that may either disappeared or expanded at remission.Disappearing clones exhibited a naive CD8+phenotype and were more likely to respond to glucocorticoid treatment.Expanding clones showed upregulation of cytotoxic T cell markers and may play a role in the transition to a chronic/relapsing phase.Finally,cytokine gene expression differed across disease phases.At relapse,pro-inflammatory cytokines such as TNF-alpha,IL-1,and IL-6 were upregulated in CD4+and CD8+T cells,while TGF-beta was downregulated,potentially in an attempt to counteract the transition to chronic phase.This is the largest study evaluating BM histology and clinical characteristics,and the first evaluation of BM microenvironment by single-cell RNA sequencing in AIHA.We showed a complex scenario encompassing T-cell infiltration,clonality,and up/down-regulation of cytokine genes,associated with a more severe and relapsing disease.展开更多
Background: Sickle cell anemia(SCA), a genetic hemoglobin disorder, suggests essential inner ear compromise and poor auditory processing. In humans, auditory processing differs physiologically between males and female...Background: Sickle cell anemia(SCA), a genetic hemoglobin disorder, suggests essential inner ear compromise and poor auditory processing. In humans, auditory processing differs physiologically between males and females, possibly true for SCA due to gender-specific disease pathophysiological changes. Objective: To investigate gender differences in psychoacoustical abilities, and speech perception in noise in SCA individuals and further compare with normal healthy(NH) population. Methods: 80 SCA and 80 NH normal-hearing participants aged 15-40 years were included and further grouped based on gender. Auditory discrimination for frequency, intensity, and duration at 500Hz and 4000Hz;temporal processing(Gap detection threshold & Modulation Detection Threshold) and Speech Perception In Noise(SPIN) at 0d BSNR tests were evaluated and compared between males and females of SCA and NH population. Results: SCA performed poorer compared to NH for all experimental measures. In the NH population, males performed poorer than females in psychoacoustical measures whereas within the SCA population, the reverse was true. Female participants performed better in the SPIN test in both populations. Conclusions: The adverse impact of SCA on the auditory system due to circulatory changes might cause poorer performance in SCA. Poorer performance by Female SCA is possibly due to the contrary impact of lower Hb level overlying Sickle disease.Estrogen levels and gender preference in auditory processing might lead to better performance by females within the NH population. SPIN performance depends on different attentional demands and sensorimotor processing strategies in noise beyond psychoacoustical processing may lead to better female performance in both populations.展开更多
Objective Acquired aplastic anemia(aAA)is characterized by an autologous immunological attack against hematopoietic stem and progenitor cells,and immunotolerance disruption is frequent,with reduced T regulatory cells(...Objective Acquired aplastic anemia(aAA)is characterized by an autologous immunological attack against hematopoietic stem and progenitor cells,and immunotolerance disruption is frequent,with reduced T regulatory cells(Tregs)frequencies and increased effector cytotoxic cells.Tregs are reduced in aAA and increase in number after successful immunosuppressive therapies.Methods In this retrospective study,we investigated the frequency of circulating Tregs by multiparametric flow cytometry immunophenotyping in non-severe aAA patients before and after immunosuppressive therapy.The samples were stained with the following antibodies:ECD anti-CD3,PE or PC5 anti-CD4,FITC anti-CD8,and PE anti-CD25,and Tregs were identified by first gating on linear parameters for lymphocyte identification and then for CD3 expression.In CD3+CD4+cells,Tregs were further identified on the basis of CD25 and FOXP3 expression.Results Although the number of Tregs tended to increase after immunosuppressive treatments,their circulating frequency remained lower than that of healthy subjects,regardless of their responsiveness to therapies.Moreover,the relative frequency combined with absolute Treg counts might be more informative in the differential diagnosis of bone marrow failure syndromes.Conclusions The persistent decrease in circulating Tregs could be the result of immunosuppressive agents that could preferentially expand other T-cell subsets.At the same time,an imbalance in immunotolerance might persist,which is also favored by chronic antigen stimulation.展开更多
Objective:To observe the effects of moxibustion on the hematopoietic function in mice with aplastic anemia(AA)induced by bone marrow(BM)suppression,and to investigate the intervention effects of moxibustion on AA from...Objective:To observe the effects of moxibustion on the hematopoietic function in mice with aplastic anemia(AA)induced by bone marrow(BM)suppression,and to investigate the intervention effects of moxibustion on AA from the perspective of intestinal bacteria.Methods:A total of 24 C57BL/6 J male mice were randomly and evenly divided into control,model and moxibustion groups.The myelosuppression-induced AA model was established by cyclophosphamide(CTX)and cyclosporine(Cs)intraperitoneal injection.Mice in the moxibustion group were intervened in mild moxibustion at unilateral“Zusanli(ST36)”acupoint for 15 min per day,and the sides were switched the next day.The intervention of mild moxibustion lasted 60 days consecutively.The red blood cell(RBC),white blood cell(WBC),platelet(PLT)counts and haemoglobin(Hb)concentration levels of mice in each group were detected by peripheral blood cells count staining,and the BM hematopoietic cells and hematopoietic structures were observed by BM smear Wright-Giemsa staining and HE staining.16SrDNA sequencing was used to analyze the gut bacterial species abundance and diversity in mice from each group.Results:After all the intervention,compared to the control group,the model group had lower levels of RBC,WBC,PLT counts and Hb concentration in peripheral blood(P<0.05)and fewer hematopoietic cells and hematopoietic structures;compared to the model group,moxibustion group had higher levels of RBC,WBC,PLT counts and Hb concentration in peripheral blood(P<0.05),and more BM hematopoietic cells and hematopoietic structures.Gut flora showed that moxibustion increased the species richness and diversity of intestinal bacteria in mice;compared with the control group,the relative abundance of Faecalibaculum and Anaeroplasmataceae in the model group was higher(P<0.05);whereas,the relative abundance of Faecalibaculum and Anaeroplasmataceae in the moxibustion group was lower(P<0.05)when compared with the model group.In addition,Faecalibaculum was significantly correlated with RBC,WBC,PLT count and Hb concentration(P<0.05).Conclusion:Moxibustion can improved BM histology,restored hematopoietic cells function,and increased peripheral blood cells count and Hb concentration in AA mice.The mechanism may be related to the fact that moxibustion regulates the abundance of specific intestinal bacteria to maintain the stability of the flora structure.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)are a major complication of diabetes mellitus,and anemia is commonly observed in diabetic patients.However,the relationship between anemia and the risk of developing DFUs remains u...BACKGROUND Diabetic foot ulcers(DFUs)are a major complication of diabetes mellitus,and anemia is commonly observed in diabetic patients.However,the relationship between anemia and the risk of developing DFUs remains unclear.AIM To investigate the relationship between anemia and the risk of DFUs in diabetic patients through a meta-analysis.METHODS A systematic search was conducted across PubMed,Embase,and Web of Science databases to identify studies that reported the co-occurrence of anemia and DFUs in diabetic patients.The primary outcome was an association between anemia and DFU risk,expressed as odds ratios(ORs).Secondary outcomes included the risk of DFU per 1-g/dL decrease in hemoglobin and the difference in hemoglobin le-vels between patients with and without DFU.Statistical analyses were performed using random-effects models to account for heterogeneity.RESULTS Sixteen studies involving 170,949 diabetic patients were included in the analysis.The results indicated a significant association between anemia and an increased risk of DFUs(eight studies,n=166173,OR:2.72,95%CI:1.73–4.25,P<0.001;I2=93%).Subgroup analyses sup-ported consistent findings across various patient characteristics,analytic models,and study quality scores(P for subgroup differences,all>0.05).Additionally,each 1-g/dL decrease in hemoglobin was associated with an excess risk of DFUs(four studies,n=2543,OR:1.65,95%CI:1.21–2.27,P=0.002;I2=68%).Furthermore,diabetic patients with DFUs exhibited significantly lower hemoglobin levels compared to those without DFUs(nine studies,n=3986,mean difference:-2.13 g/dL,95%CI:-2.58 to-1.68,P<0.001;I2=90%).CONCLUSION Anemia can be associated with an increased risk of DFUs in diabetic patients.Monitoring and managing anemia in diabetic population may help mitigate the risk of DFUs,emphasizing the need for early interventions.Further research is required to investigate the underlying mechanisms and potential therapeutic strategies.展开更多
BACKGROUND Anemia is a prevalent and challenging complication in patients with hematologic and solid malignancies,which stems from the direct effects of malignancy,treatment-induced toxicities,and systemic inflammatio...BACKGROUND Anemia is a prevalent and challenging complication in patients with hematologic and solid malignancies,which stems from the direct effects of malignancy,treatment-induced toxicities,and systemic inflammation.It affects patients’survival,functional status,and quality of life profoundly.Recent literature has highlighted the emerging role of the gut microbiome in the pathogenesis of cancer-associated anemia.The gut microbiota,through its intricate interplay with iron metabolism,inflammatory pathways,and immune modulation,may either exacerbate or ameliorate anemia depending on its composition,and functional integrity.Dysbiosis,characterized by disruption in the gut microbial ecosystem,is very common in cancer patients.This microbial imbalance is implicated in anemia causation through diminished iron absorption,persistent low-grade inflammation,and suppression of erythropoiesis.AIM To consolidate current evidence regarding the interplay between gut microbiome and anemia in the setting of malignancies.It aims to provide a detailed exploration of the mechanistic links between dysbiosis and anemia,identifies unique challenges associated with various cancer types,and evaluates the efficacy of microbiome-focused therapies.Through this integrative approach,the review seeks to establish a foundation for innovative clinical strategies aimed at mitigating anemia and improving patient outcomes in oncology.METHODS A literature search was performed using multiple databases,including Google Scholar,PubMed,Scopus,and Web of Science,using a combination of keywords and Boolean operators to refine results.Keywords included“cancerassociated anemia”,“gut microbiome”,“intestinal microbiota”,“iron metabolism”,“gut dysbiosis”,“short-chain fatty acids”,“hematopoiesis”,“probiotics”,“prebiotics”,and“fecal microbiota transplantation”.Articles published in English between 2000 and December 2024 were included,with a focus on contemporary and relevant findings.RESULTS Therapeutic strategies aimed at restoration of gut microbial homeostasis,such as probiotics,prebiotics,dietary interventions,and fecal microbiota transplantation(FMT),can inhibit anemia-causing pathways by enhancing microbial diversity,suppressing detrimental flora,reducing systemic inflammation and optimizing nutrient absorption.CONCLUSION Gut dysbiosis causes anemia and impairs response to chemotherapy in cancer patients.Microbiome-centered interventions,such as probiotics,prebiotics,dietary modifications,and FMT,have shown efficacy in restoring microbial balance,reducing inflammation,and enhancing nutrient bioavailability.Emerging approaches,including engineered probiotics and bacteriophage therapies,are promising precision-based,customizable solutions for various microbiome compositions and imbalances.Future research should focus on integrating microbiometargeted strategies with established anemia therapies.展开更多
The review by Bangolo et al highlights the role of the gut microbiome in cancerassociated anemia(CAA).However,the impact of microbiome-derived metabolites is underexplored.In this letter,we focus on short-chain fatty ...The review by Bangolo et al highlights the role of the gut microbiome in cancerassociated anemia(CAA).However,the impact of microbiome-derived metabolites is underexplored.In this letter,we focus on short-chain fatty acids,tryptophan metabolites,and polyamines as key mediators linking dysbiosis to impaired erythropoiesis and iron homeostasis.We also propose a research framework that integrates multi-omics analysis and gnotobiotic models.Finally,we discuss the clinical potential of metabolite-based diagnostics and microbiome-targeted therapies in managing CAA.展开更多
Anemia is still prevalent among low and middle-income countries,posing serious family and social burdens.However,scarce studies provided evidence for real-world exposure to polycyclic aromatic hydrocarbons(PAHs)and an...Anemia is still prevalent among low and middle-income countries,posing serious family and social burdens.However,scarce studies provided evidence for real-world exposure to polycyclic aromatic hydrocarbons(PAHs)and anemia among pregnant women,as well as involved biological mechanisms.So,we conducted this study including 1717 late pregnant women fromZunyi Birth Cohort and collected urine samples for PAHs metabolites detection.Logistic regression and restricted cubic spline regression were used to examine exposuredisease risks and dose-response relationships.We conducted Bayesian kernel machine regression,weighted quantile sum regression,and quantile g-computation regression to fit the joint impacts of multiple PAHs in the real-world scenario on hypocalcemia and anemia.Results showed single exposure to 2-OHNap,2-OHFlu,9-OHFlu,1-OHPhe,2-OHPhe,3-OHPhe,and 1-OHPyr(all P-trend<0.05)increased the risks of hypocalcemia and anemia.Moreover,PAHs mixture was significantly related to higher risks of hypocalcemia and anemia,with 3-OHPhe and 1-OHPyr identified as their major drivers,respectively.Importantly,hypocalcemia served as a significant biological mechanism responsible for PAHs and anemia.Our findings suggest that individual and joint exposure to PAHs during late pregnancy elevate the anemia risk,and calcium supplementation might be a low-cost intervention target for reducing the PAHs-related impairment on anemia for pregnant women.展开更多
Iron deficiency anemia(IDA)is a nutritional deficiency disease with a high incidence rate worldwide.Bioactive peptides are safe and effective,have multiple functions and can serve as potential candidates for alleviati...Iron deficiency anemia(IDA)is a nutritional deficiency disease with a high incidence rate worldwide.Bioactive peptides are safe and effective,have multiple functions and can serve as potential candidates for alleviating IDA.In this study,the anti-anemia effects of tuna dark muscle peptides were explored in a dietinduced IDA mouse model.The results showed that tuna dark muscle peptides alleviated the IDA phenotype,oxidative stress and iron metabolism.In addition,tuna dark muscle peptides reversed gut microbiota dysbiosis in IDA mice.Furthermore,the transplanted fecal microbiota from tuna dark muscle peptide-treated mice also alleviated IDA symptoms and regulated iron metabolism and the gut microbiota,indicating that the antianemic effects were at least partially mediated by the gut microbiota.Thus,we identified a new and safe prebiotic material to alleviate IDA and provided ideas for the development of peptides.At the same time,these data also provided a theoretical basis for fecal microbiota transplantation to alleviate IDA.展开更多
The prevalence of iron deficiency anemia(IDA)remains high in infants,resulting in growth retardation,neurodevelopmental impairment,immunodeficiency and other irreversible injuries.Efficient and safe iron supplementati...The prevalence of iron deficiency anemia(IDA)remains high in infants,resulting in growth retardation,neurodevelopmental impairment,immunodeficiency and other irreversible injuries.Efficient and safe iron supplementation for infants has been the goal of recent research.This study aims to investigate the effect of encapsulated ferric pyrophosphate(FePP)on intestinal inflammation and gut microbiota in IDA suckling rats.Newborn Sprague-Dawley rats were gavaged with low and high doses of FePP and FeSO4(2 and 10 mg Fe/kg BW,respectively)during postnatal days 2-14,while the Ctrl group was gavaged with saline.Results showed that FePP supplementation was as effective as FeSO4 in promoting growth,alleviating anemia and restoring body iron levels.Both low and high doses of FePP could significantly down-regulate the expression of pro inflammatory cytokines in the colon to the level similar to that in the Ctrl group(P>0.05).However,the high dose of FeSO4 did not show a down-regulation effect.Compared with the Ctrl group,IDA caused a disturbance of gut microbiota composition in suckling rats,and FePP could restore this dysbiosis.Besides,FePP was more beneficial than FeSO4 in increasing the abundance of beneficial bacteria such as Bacteroides and Akkermansia.Spearman’s correlation analysis showed a correlation between gut microbiota and biochemical indicators such as iron status,pro-inflammatory cytokine expression,and oxidative stress level.Overall,these findings suggested that FePP could effectively improve IDA,and is more effective than FeSO4 in alleviating intestinal inflammation and regulating gut microbiota,which provides a basis for the application of new iron fortificant in infant formula.展开更多
Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),which is responsible for coronavirus disease 2019(COVID-19),has infected>700 million people and led to>7 million deaths worldwide.Although COVID-19 pri...Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),which is responsible for coronavirus disease 2019(COVID-19),has infected>700 million people and led to>7 million deaths worldwide.Although COVID-19 primarily affects the lungs,it can also affect the kidneys through various pathways.SARS-CoV-2 affects the kidney via several common mechanisms,such as dysregulation of angiotensin-converting enzyme 2,transmembrane serine protease 2 and tissue proteinase L expression in kidney tissue.People with chronic kidney disease(CKD)and COVID-19 have an increased risk of mortality and hospitalization in the intensive care unit.Anemia,a common consequence of CKD,is also associated with worsening outcomes in COVID-19 patients.In these patients with multiple comorbidities,there is a sharp increase in D-dimers,inflammatory parameters,creatinine and blood urea nitrogen.COVID-19 patients also present with resis-tance to erythropoietin(EPO)-stimulating agents,which necessitates elevated dosages even several months post-infection.In CKD,anemia is exacerbated by decreased EPO production,red blood cell(RBC)fragmentation due to impairment of the renovascular endothelium in situations such as glomerulopathy and mali-gnant hypertension.Other factors include iron and/or folic acid deficiency,bleeding due to platelet dysfunction,inflammation,reduced RBC lifespan,poor iron utilization,uremia,and atypical blood loss after dialysis.Excessive hepcidin synthesis impairs the absorption of dietary iron and the mobilization of iron from endogenous reserves,thus contributing significantly to anemia and poor iron regulation in CKD.These findings suggest that CKD may contribute to the occurrence of anemia in COVID-19 patients,especially in older people with comorbidities.Our review aims to explore the complex relationship between CKD,COVID-19 and anemia to improve our understanding of the underlying mechanisms of the disease and the potential cofactors that worsen outcomes in these patients.展开更多
Microscopic polyangiitis (MPA) is an autoimmune disorder characterized by pulmonary capillaritis and necrotizing glomerulonephritis triggered by the deposition of oligoimmune complexes.This condition primarily aff ect...Microscopic polyangiitis (MPA) is an autoimmune disorder characterized by pulmonary capillaritis and necrotizing glomerulonephritis triggered by the deposition of oligoimmune complexes.This condition primarily aff ects the lungs and kidneys.^([1])The key pathological features in the lungs associated with MPA include pulmonary interstitial fibrosis and diffuse alveolar hemorrhage (DAH),which clinically present as cough,sputum production,hemoptysis,and dyspnea.[2] In this report,we present a patient with MPA complicated by severe anemia and DAH,notably without the typical symptoms of hemoptysis.展开更多
Objective: To analyze the effectiveness of blood test indicators in the differential diagnosis of anemia. Methods: Sixty patients diagnosed with anemia (disease group) from June 2021 to June 2024 were selected. Based ...Objective: To analyze the effectiveness of blood test indicators in the differential diagnosis of anemia. Methods: Sixty patients diagnosed with anemia (disease group) from June 2021 to June 2024 were selected. Based on the type of disease, the group was subdivided into iron deficiency anemia (IDA) with 31 cases, hemolytic anemia (HA) with 11 cases, and aplastic anemia (AA) with 18 cases. Based on the severity of the disease, the group was divided into mild anemia (30 cases), moderate anemia (19 cases), and severe anemia (11 cases). Sixty healthy individuals (control group) were also included, and all underwent blood tests. Comparisons were made between the red blood cell (RBC) indicators of the disease group and the control group, the blood test indicators of different types of anemia, and the serum iron levels of varying severity of anemia. Results: Except for red cell distribution width (RDW), the RBC indicators in the disease group were lower than those in the control group (P < 0.05). Comparisons of RBC indicators among different types of anemia showed significant differences (P < 0.05). Serum iron levels varied significantly among different degrees of anemia severity (P < 0.05). Conclusion: Blood tests can detect anemia, distinguish types of anemia, and assess anemia severity, offering high diagnostic value.展开更多
BACKGROUND Gastrointestinal stromal tumors(GISTs)are caused by mutations in the KIT and platelet derived growth factor receptor alpha genes in approximately 90%of cases.A minority of wild-type GISTs are associated wit...BACKGROUND Gastrointestinal stromal tumors(GISTs)are caused by mutations in the KIT and platelet derived growth factor receptor alpha genes in approximately 90%of cases.A minority of wild-type GISTs are associated with neurofibromatosis type 1(NF1),an autosomal dominant genetic disease resulting from pathogenic mutations in the NF1 gene,which encodes the neurofibromin protein.NF1 patients often exhibit multi-system involvement,with café-au-lait macules and neurofibromas being characteristic symptoms.GISTs are a rare complication of NF1,with the tumors most frequently occurring in the small intestine(90%of cases),while occurrences in the stomach are rare.CASE SUMMARY A 51-year-old woman presented to the emergency department with complaints of dizziness,fatigue,chest tightness,and dark stools.Initial examination revealed a red blood cell count of 1.99×1012/L and a hemoglobin level of 43 g/L.She underwent blood transfusions and fluid replacement to stabilize her condition.Further investigations identified typical café-au-lait macules on her trunk,limbs,and face,along with neurofibromas.Endoscopy showed coffee-colored fluid in the gastric cavity,a large submucosal elevation with an exudative covering,and ulcer formation on the gastric fundus.Exploratory laparoscopy confirmed the tumor’s origin in the gastric fundus,and resection of the giant GIST was performed.Pathological analysis revealed a necrotic GIST measuring 18 cm×14 cm,classified as high-risk,with approximately 5 mitotic figures per 10 high-power fields and no tumor at the margins.Immunohistochemistry results were CD117(+),delay of germination 1(+),CD34(+),and succinate dehydrogenase complex iron sulfur subunit B intact expression.Genetic testing using next-generation sequencing confirmed an NF1 gene mutation.The patient underwent successful tumor resection and was discharged home with postoperative regorafenib therapy.A follow-up at one year showed no recurrence.CONCLUSION Given the diversity of clinical symptoms associated with NF1 and the complexity of NF1-related GISTs,surgical resection with complete tumor removal remains the preferred treatment option.However,the absence of a standardized treatment protocol for adjuvant therapy presents numerous challenges for clinicians.展开更多
OBJECTIVE:To investigate the effect of Shisiwei Jianzhong decoction(十四味建中汤,SJD)on non-severe aplastic anemia(NSAA).METHODS:Bone marrow mesenchymal stem cells(BMSCs)were isolated from bone marrow samples of 15 NS...OBJECTIVE:To investigate the effect of Shisiwei Jianzhong decoction(十四味建中汤,SJD)on non-severe aplastic anemia(NSAA).METHODS:Bone marrow mesenchymal stem cells(BMSCs)were isolated from bone marrow samples of 15 NSAA patients and 3 healthy controls.Cells were treated with gradient concentrations of SJD,and a portion was transfected with a vector overexpressing the nuclear factor of activated T cells,cytoplasmic 4(NFATC4).Cell viability and apoptosis were detected by cell counting kit-8 and flow cytometry,respectively.After adipogenic differentiation induction,lipid droplet formation in BMSCs was examined by Oil Red O staining.The expression of NFATC4,peroxisome proliferator-activated receptor gamma(PPARG),fatty acid-binding protein 4(FABP4),peroxisome proliferator-activated receptor-gamma coactivator(PGC-1α),and acetylated PGC-1αwas measured by quantitative real-time polymerase chain reaction or Western blot.RESULTS:SJD significantly increased the viability and decreased the apoptosis of NSAA-derived BMSCs.It also dose-dependently inhibited lipid droplet formation and decreased the expression of PPARG and FABP4 in NSAA-derived BMSCs.NFATC4 expression was higher in patients with NSAA than in healthy controls,and SJD downregulated its expression.NFATC4 overexpression reversed the inhibitory effect of SJD on adipogenic differentiation.Additionally,SJD promoted the deacetylation of PGC-1αin NSAA-derived BMSCs,which was also partially eliminated by NFATC4 overexpression.CONCLUSIONS:SJD inhibits adipogenic differentiation of BMSCs through downregulating NFATC4,thereby contributing to the remission of NSAA.展开更多
To investigate the efficacy of a structured continuous nursing intervention program on clinical outcomes,self-efficacy,and sleep quality in patients diagnosed with aplastic anemia(AA).Methods:This study was a single-c...To investigate the efficacy of a structured continuous nursing intervention program on clinical outcomes,self-efficacy,and sleep quality in patients diagnosed with aplastic anemia(AA).Methods:This study was a single-center,parallel-group,randomized controlled trial.A total of 64 patients with AA,treated at our hospital’s hematology department from May 2022 to May 2025,were enrolled.Participants were randomly allocated in a 1:1 ratio to either the control group(n=32),receiving routine nursing care,or the intervention group(n=32),receiving a six-month continuous nursing intervention program in addition to routine care.The intervention program consisted of structured health education,individualized psychological support,regular telephone follow-ups,and a 24/7 online communication platform.The primary outcome was the change in the Pittsburgh Sleep Quality Index(PSQI)score from baseline to six months.Secondary outcomes included hematological parameters(hemoglobin[Hb],absolute neutrophil count[ANC],platelet count[PLT]),incidence of adverse events(infections,bleeding episodes),quality of life(assessed by the Functional Assessment of Cancer Therapy–Anemia[FACT-An]),and self-efficacy(assessed by the General Self-Efficacy Scale[GSE]).Statistical analyses were performed using independent t-tests,and chi-square tests or Fisher’s exact tests as appropriate.Results:A total of 55 patients(28 in the intervention group and 27 in the control group)completed the study.At baseline,there were no statistically significant differences in demographic data,clinical characteristics,or outcome measures between the two groups(p>0.05).After six months,the mean PSQI score in the intervention group was significantly lower than that in the control group(7.12±2.05 vs.13.49±2.88;t=−13.450;p<0.001).The intervention group also demonstrated a significantly lower incidence of infections(4/28,14.29%vs.10/27,37.04%;p=0.048)and bleeding episodes requiring intervention(3/28,10.71%vs.9/27,33.33%;p=0.042).Furthermore,patients in the intervention group reported significantly higher scores on the FACT-An(125.70±10.31 vs.109.44±12.10;t=7.934;p<0.001)and the GSE scale(29.82±4.11 vs.23.51±4.80;t=7.311;p<0.001).While hematological parameters showed a trend toward improvement in the intervention group,the differences were not statistically significant compared to the control group(p>0.05).Conclusion:The implementation of a structured continuous nursing intervention program can significantly improve sleep quality,reduce the incidence of complications,and enhance quality of life and self-efficacy in patients with aplastic anemia.This evidence-based model of care should be considered for integration into standard clinical practice for the long-term management of this patient population.展开更多
Anemia is a common yet often overlooked complication in patients with type 2 diabetes mellitus(T2DM),particularly those with chronic kidney disease.It significantly impacts patients'quality of life,cardiovascular ...Anemia is a common yet often overlooked complication in patients with type 2 diabetes mellitus(T2DM),particularly those with chronic kidney disease.It significantly impacts patients'quality of life,cardiovascular health,and treatment outcomes.Despite its high prevalence,current clinical guidelines lack specific recommendations for anemia prevention and management in T2DM,especially in the context of newer antidiabetic therapies.This review explores the potential of emerging antidiabetic medications,such as sodium-glucose cotransporter-2 inhibitors,glucagon-like peptide-1 receptor agonists(GLP-1 RAs),and combined GLP-1-RA/GIP to mitigate anemia risk.Early detection and management of anemia in T2DM patients are crucial for improving glycemic control,reducing cardiovascular morbidity,and enhancing overall treatment outcomes.This review underscores the need for further research to better understand the mechanisms by which these novel therapies influence anemia risk and to integrate these findings into clinical practice.展开更多
BACKGROUND Congenital sideroblastic anemia(CSA)is a rare and heterogeneous group of genetic disorders.Conventional treatment include pyridoxine(vitamin B6)and allogeneic hematopoietic stem cell transplantation(allo-HS...BACKGROUND Congenital sideroblastic anemia(CSA)is a rare and heterogeneous group of genetic disorders.Conventional treatment include pyridoxine(vitamin B6)and allogeneic hematopoietic stem cell transplantation(allo-HSCT),and can alleviate anemia in the majority of cases.Nevertheless,some CSA cases remain unresponsive to pyridoxine or are unable to undergo allo-HSCT.Novel management approaches is necessary to be developed.To explore the response of luspatercept in treating congenital sideroblastic anemia.CASE SUMMARY We share our experience in luspatercept in a 4-year-old male patient with CSA.Luspatercept was administered subcutaneously at doses of 1.0 mg/kg/dose to 1.25 mg/kg/dose every 3 wk,three consecutive doses,evaluating the hematological response.Luspatercept leading to a significant improvement in the patient's anemia.The median hemoglobin during the overall treatment with three doses of luspatercept was 90(75-101)g/L,the median absolute reticulocyte count was 0.0593(0.0277-0.1030)×10^(12)/L,the median serum ferritin was 304.3(234.4-399)ng/mL,and the median lifespan of mature red blood cells was 80(57-92)days.Notably,no adverse reactions,such as headaches,dizziness,vomiting,joint pain,or back pain,were observed during the treatment period.CONCLUSION We believe that luspatercept might emerge as a viable therapeutic option for the maintenance treatment of CSA or as a bridging treatment option before hematopoietic stem cell transplantation.展开更多
BACKGROUND Exertional heat stroke(EHS)is a critical condition arising from prolonged physical exertion in high temperatures that typically presents with normal hemoglobin levels.However,atypical presentations can also...BACKGROUND Exertional heat stroke(EHS)is a critical condition arising from prolonged physical exertion in high temperatures that typically presents with normal hemoglobin levels.However,atypical presentations can also occur,leading to significant complications such as hemolytic anemia and organ dysfunction.CASE SUMMARY This case report describes a male patient who experienced moderate-to-severe anemia that was difficult to correct,with a confirmed diagnosis of microangiopathic hemolytic anemia accompanying multiple organ dysfunction syndrome,indicative of critical EHS.Despite intensive resuscitation efforts,the patient’s condition deteriorated,necessitating admission to the intensive care unit for advanced management.CONCLUSION This case highlights the importance of recognizing atypical presentations of EHS,particularly that with significant hemolytic anemia and concurrent organ failure.Clinicians should maintain a high level of suspicion for these complications in patients displaying symptoms of heat-related illness,especially when caused by strenuous activity,as early diagnosis and intervention are crucial to improve patient outcomes.展开更多
Iron deficiency anemia(IDA)continues to be a global public health problem.Oral iron is the universally accepted first-line therapy,and most children have a prompt and favorable response to oral formulations.In subsets...Iron deficiency anemia(IDA)continues to be a global public health problem.Oral iron is the universally accepted first-line therapy,and most children have a prompt and favorable response to oral formulations.In subsets of children who fail to respond due to intolerance,poor adherence,or inadequate intestinal absorption,parenteral iron is indicated.Despite numerous studies in adults with IDA of diverse etiologies,pediatric studies on parenteral iron use are very limited.Although mostly retrospective and small,these studies have documented the efficacy and safety profile of intravenous iron formulations.In this editorial the author comments on the most important published data and underscores the need to seriously consider parenteral iron use in children unresponsive to oral therapy.展开更多
基金funded by Umberto Veronesi Foundation and Pfizer Global Medical Grants(grant tracking number 75340503)supported by the European Research Council under the European Union’s Horizon 2020 research and innovation pro-gram(grant agreement number 817997)+1 种基金Associazione Italiana Ricerca sul Cancro(grant IG25739)supported in part by Italian Ministry of Health,current research IRCCS.
文摘The role of bone marrow(BM)compensatory response in autoimmune hemolytic anemias(AIHAs)is emerging and inadequate reticulocytosis has been associated with more severe disease and adverse outcomes.However,few is known about the BM immunologic microenvironment composition in these diseases.Here we investigated BM features in a large cohort of 97 patients with autoimmune hemolytic anemia(AIHA)and observed a high prevalence of hypercellularity,dyserythropoiesis,reticulin fibrosis,and T-cell infiltration(65%,29%,76%,and 69%of patients,respectively).These findings were associated with inadequate bone marrow compensation,more severe anemia at onset,and need of multiple treatments.In a subset of warm type AIHA patients we investigated BM microenvironment by single-cell RNA sequencing.We found distinct immune cell profiles across disease stages(diagnosis,remission,relapse).In particular,upregulation of inflammatory response pathways was noted in CD8+,CD4+,and monocyte subsets during relapse compared to diagnosis and remission.Moreover,by single-cell TCR sequencing,we found small T cell clones at diagnosis that may either disappeared or expanded at remission.Disappearing clones exhibited a naive CD8+phenotype and were more likely to respond to glucocorticoid treatment.Expanding clones showed upregulation of cytotoxic T cell markers and may play a role in the transition to a chronic/relapsing phase.Finally,cytokine gene expression differed across disease phases.At relapse,pro-inflammatory cytokines such as TNF-alpha,IL-1,and IL-6 were upregulated in CD4+and CD8+T cells,while TGF-beta was downregulated,potentially in an attempt to counteract the transition to chronic phase.This is the largest study evaluating BM histology and clinical characteristics,and the first evaluation of BM microenvironment by single-cell RNA sequencing in AIHA.We showed a complex scenario encompassing T-cell infiltration,clonality,and up/down-regulation of cytokine genes,associated with a more severe and relapsing disease.
文摘Background: Sickle cell anemia(SCA), a genetic hemoglobin disorder, suggests essential inner ear compromise and poor auditory processing. In humans, auditory processing differs physiologically between males and females, possibly true for SCA due to gender-specific disease pathophysiological changes. Objective: To investigate gender differences in psychoacoustical abilities, and speech perception in noise in SCA individuals and further compare with normal healthy(NH) population. Methods: 80 SCA and 80 NH normal-hearing participants aged 15-40 years were included and further grouped based on gender. Auditory discrimination for frequency, intensity, and duration at 500Hz and 4000Hz;temporal processing(Gap detection threshold & Modulation Detection Threshold) and Speech Perception In Noise(SPIN) at 0d BSNR tests were evaluated and compared between males and females of SCA and NH population. Results: SCA performed poorer compared to NH for all experimental measures. In the NH population, males performed poorer than females in psychoacoustical measures whereas within the SCA population, the reverse was true. Female participants performed better in the SPIN test in both populations. Conclusions: The adverse impact of SCA on the auditory system due to circulatory changes might cause poorer performance in SCA. Poorer performance by Female SCA is possibly due to the contrary impact of lower Hb level overlying Sickle disease.Estrogen levels and gender preference in auditory processing might lead to better performance by females within the NH population. SPIN performance depends on different attentional demands and sensorimotor processing strategies in noise beyond psychoacoustical processing may lead to better female performance in both populations.
文摘Objective Acquired aplastic anemia(aAA)is characterized by an autologous immunological attack against hematopoietic stem and progenitor cells,and immunotolerance disruption is frequent,with reduced T regulatory cells(Tregs)frequencies and increased effector cytotoxic cells.Tregs are reduced in aAA and increase in number after successful immunosuppressive therapies.Methods In this retrospective study,we investigated the frequency of circulating Tregs by multiparametric flow cytometry immunophenotyping in non-severe aAA patients before and after immunosuppressive therapy.The samples were stained with the following antibodies:ECD anti-CD3,PE or PC5 anti-CD4,FITC anti-CD8,and PE anti-CD25,and Tregs were identified by first gating on linear parameters for lymphocyte identification and then for CD3 expression.In CD3+CD4+cells,Tregs were further identified on the basis of CD25 and FOXP3 expression.Results Although the number of Tregs tended to increase after immunosuppressive treatments,their circulating frequency remained lower than that of healthy subjects,regardless of their responsiveness to therapies.Moreover,the relative frequency combined with absolute Treg counts might be more informative in the differential diagnosis of bone marrow failure syndromes.Conclusions The persistent decrease in circulating Tregs could be the result of immunosuppressive agents that could preferentially expand other T-cell subsets.At the same time,an imbalance in immunotolerance might persist,which is also favored by chronic antigen stimulation.
基金Supported by the State Administration of Traditional Chinese Medicine high-level key disciplines construction project:zyyzdxk-2023068Three-year Action Plan for Shanghai TCM Development and Inheritance Program:ZY(2021-2023)-0302。
文摘Objective:To observe the effects of moxibustion on the hematopoietic function in mice with aplastic anemia(AA)induced by bone marrow(BM)suppression,and to investigate the intervention effects of moxibustion on AA from the perspective of intestinal bacteria.Methods:A total of 24 C57BL/6 J male mice were randomly and evenly divided into control,model and moxibustion groups.The myelosuppression-induced AA model was established by cyclophosphamide(CTX)and cyclosporine(Cs)intraperitoneal injection.Mice in the moxibustion group were intervened in mild moxibustion at unilateral“Zusanli(ST36)”acupoint for 15 min per day,and the sides were switched the next day.The intervention of mild moxibustion lasted 60 days consecutively.The red blood cell(RBC),white blood cell(WBC),platelet(PLT)counts and haemoglobin(Hb)concentration levels of mice in each group were detected by peripheral blood cells count staining,and the BM hematopoietic cells and hematopoietic structures were observed by BM smear Wright-Giemsa staining and HE staining.16SrDNA sequencing was used to analyze the gut bacterial species abundance and diversity in mice from each group.Results:After all the intervention,compared to the control group,the model group had lower levels of RBC,WBC,PLT counts and Hb concentration in peripheral blood(P<0.05)and fewer hematopoietic cells and hematopoietic structures;compared to the model group,moxibustion group had higher levels of RBC,WBC,PLT counts and Hb concentration in peripheral blood(P<0.05),and more BM hematopoietic cells and hematopoietic structures.Gut flora showed that moxibustion increased the species richness and diversity of intestinal bacteria in mice;compared with the control group,the relative abundance of Faecalibaculum and Anaeroplasmataceae in the model group was higher(P<0.05);whereas,the relative abundance of Faecalibaculum and Anaeroplasmataceae in the moxibustion group was lower(P<0.05)when compared with the model group.In addition,Faecalibaculum was significantly correlated with RBC,WBC,PLT count and Hb concentration(P<0.05).Conclusion:Moxibustion can improved BM histology,restored hematopoietic cells function,and increased peripheral blood cells count and Hb concentration in AA mice.The mechanism may be related to the fact that moxibustion regulates the abundance of specific intestinal bacteria to maintain the stability of the flora structure.
基金Supported by General Program of Hainan Natural Science Foundation,No.824MS143.
文摘BACKGROUND Diabetic foot ulcers(DFUs)are a major complication of diabetes mellitus,and anemia is commonly observed in diabetic patients.However,the relationship between anemia and the risk of developing DFUs remains unclear.AIM To investigate the relationship between anemia and the risk of DFUs in diabetic patients through a meta-analysis.METHODS A systematic search was conducted across PubMed,Embase,and Web of Science databases to identify studies that reported the co-occurrence of anemia and DFUs in diabetic patients.The primary outcome was an association between anemia and DFU risk,expressed as odds ratios(ORs).Secondary outcomes included the risk of DFU per 1-g/dL decrease in hemoglobin and the difference in hemoglobin le-vels between patients with and without DFU.Statistical analyses were performed using random-effects models to account for heterogeneity.RESULTS Sixteen studies involving 170,949 diabetic patients were included in the analysis.The results indicated a significant association between anemia and an increased risk of DFUs(eight studies,n=166173,OR:2.72,95%CI:1.73–4.25,P<0.001;I2=93%).Subgroup analyses sup-ported consistent findings across various patient characteristics,analytic models,and study quality scores(P for subgroup differences,all>0.05).Additionally,each 1-g/dL decrease in hemoglobin was associated with an excess risk of DFUs(four studies,n=2543,OR:1.65,95%CI:1.21–2.27,P=0.002;I2=68%).Furthermore,diabetic patients with DFUs exhibited significantly lower hemoglobin levels compared to those without DFUs(nine studies,n=3986,mean difference:-2.13 g/dL,95%CI:-2.58 to-1.68,P<0.001;I2=90%).CONCLUSION Anemia can be associated with an increased risk of DFUs in diabetic patients.Monitoring and managing anemia in diabetic population may help mitigate the risk of DFUs,emphasizing the need for early interventions.Further research is required to investigate the underlying mechanisms and potential therapeutic strategies.
文摘BACKGROUND Anemia is a prevalent and challenging complication in patients with hematologic and solid malignancies,which stems from the direct effects of malignancy,treatment-induced toxicities,and systemic inflammation.It affects patients’survival,functional status,and quality of life profoundly.Recent literature has highlighted the emerging role of the gut microbiome in the pathogenesis of cancer-associated anemia.The gut microbiota,through its intricate interplay with iron metabolism,inflammatory pathways,and immune modulation,may either exacerbate or ameliorate anemia depending on its composition,and functional integrity.Dysbiosis,characterized by disruption in the gut microbial ecosystem,is very common in cancer patients.This microbial imbalance is implicated in anemia causation through diminished iron absorption,persistent low-grade inflammation,and suppression of erythropoiesis.AIM To consolidate current evidence regarding the interplay between gut microbiome and anemia in the setting of malignancies.It aims to provide a detailed exploration of the mechanistic links between dysbiosis and anemia,identifies unique challenges associated with various cancer types,and evaluates the efficacy of microbiome-focused therapies.Through this integrative approach,the review seeks to establish a foundation for innovative clinical strategies aimed at mitigating anemia and improving patient outcomes in oncology.METHODS A literature search was performed using multiple databases,including Google Scholar,PubMed,Scopus,and Web of Science,using a combination of keywords and Boolean operators to refine results.Keywords included“cancerassociated anemia”,“gut microbiome”,“intestinal microbiota”,“iron metabolism”,“gut dysbiosis”,“short-chain fatty acids”,“hematopoiesis”,“probiotics”,“prebiotics”,and“fecal microbiota transplantation”.Articles published in English between 2000 and December 2024 were included,with a focus on contemporary and relevant findings.RESULTS Therapeutic strategies aimed at restoration of gut microbial homeostasis,such as probiotics,prebiotics,dietary interventions,and fecal microbiota transplantation(FMT),can inhibit anemia-causing pathways by enhancing microbial diversity,suppressing detrimental flora,reducing systemic inflammation and optimizing nutrient absorption.CONCLUSION Gut dysbiosis causes anemia and impairs response to chemotherapy in cancer patients.Microbiome-centered interventions,such as probiotics,prebiotics,dietary modifications,and FMT,have shown efficacy in restoring microbial balance,reducing inflammation,and enhancing nutrient bioavailability.Emerging approaches,including engineered probiotics and bacteriophage therapies,are promising precision-based,customizable solutions for various microbiome compositions and imbalances.Future research should focus on integrating microbiometargeted strategies with established anemia therapies.
文摘The review by Bangolo et al highlights the role of the gut microbiome in cancerassociated anemia(CAA).However,the impact of microbiome-derived metabolites is underexplored.In this letter,we focus on short-chain fatty acids,tryptophan metabolites,and polyamines as key mediators linking dysbiosis to impaired erythropoiesis and iron homeostasis.We also propose a research framework that integrates multi-omics analysis and gnotobiotic models.Finally,we discuss the clinical potential of metabolite-based diagnostics and microbiome-targeted therapies in managing CAA.
基金supported by the Science&Technology Program of Guizhou Province(Nos.QKHPTRC-GCC[2022]039-1,QKHPTRC-CXTD[2022]014,and QKHHBZ[2020]3002)the Scientific Research Programof Guizhou Provincial Department of Education(No.QJJ[2023]019).
文摘Anemia is still prevalent among low and middle-income countries,posing serious family and social burdens.However,scarce studies provided evidence for real-world exposure to polycyclic aromatic hydrocarbons(PAHs)and anemia among pregnant women,as well as involved biological mechanisms.So,we conducted this study including 1717 late pregnant women fromZunyi Birth Cohort and collected urine samples for PAHs metabolites detection.Logistic regression and restricted cubic spline regression were used to examine exposuredisease risks and dose-response relationships.We conducted Bayesian kernel machine regression,weighted quantile sum regression,and quantile g-computation regression to fit the joint impacts of multiple PAHs in the real-world scenario on hypocalcemia and anemia.Results showed single exposure to 2-OHNap,2-OHFlu,9-OHFlu,1-OHPhe,2-OHPhe,3-OHPhe,and 1-OHPyr(all P-trend<0.05)increased the risks of hypocalcemia and anemia.Moreover,PAHs mixture was significantly related to higher risks of hypocalcemia and anemia,with 3-OHPhe and 1-OHPyr identified as their major drivers,respectively.Importantly,hypocalcemia served as a significant biological mechanism responsible for PAHs and anemia.Our findings suggest that individual and joint exposure to PAHs during late pregnancy elevate the anemia risk,and calcium supplementation might be a low-cost intervention target for reducing the PAHs-related impairment on anemia for pregnant women.
基金sponsored by the Natural Science Foundation of Zhejiang Province(LQ22D060002 and LTGC23C190001)Fund of State Key Laboratory for Managing Biotic and Chemical Threats to the Quality and Safety of Agro-products(ZS20190105)+1 种基金General Project of Zhejiang Provincial Department of Education(Y202146257)K.C.Wong Magna Fund of Ningbo University。
文摘Iron deficiency anemia(IDA)is a nutritional deficiency disease with a high incidence rate worldwide.Bioactive peptides are safe and effective,have multiple functions and can serve as potential candidates for alleviating IDA.In this study,the anti-anemia effects of tuna dark muscle peptides were explored in a dietinduced IDA mouse model.The results showed that tuna dark muscle peptides alleviated the IDA phenotype,oxidative stress and iron metabolism.In addition,tuna dark muscle peptides reversed gut microbiota dysbiosis in IDA mice.Furthermore,the transplanted fecal microbiota from tuna dark muscle peptide-treated mice also alleviated IDA symptoms and regulated iron metabolism and the gut microbiota,indicating that the antianemic effects were at least partially mediated by the gut microbiota.Thus,we identified a new and safe prebiotic material to alleviate IDA and provided ideas for the development of peptides.At the same time,these data also provided a theoretical basis for fecal microbiota transplantation to alleviate IDA.
基金funded by the National Natural Science Foundation of China(32001676)the Young Elite Scientists Sponsorship Program by China Association for Science and Technology(CAST)(2022QNRC001).
文摘The prevalence of iron deficiency anemia(IDA)remains high in infants,resulting in growth retardation,neurodevelopmental impairment,immunodeficiency and other irreversible injuries.Efficient and safe iron supplementation for infants has been the goal of recent research.This study aims to investigate the effect of encapsulated ferric pyrophosphate(FePP)on intestinal inflammation and gut microbiota in IDA suckling rats.Newborn Sprague-Dawley rats were gavaged with low and high doses of FePP and FeSO4(2 and 10 mg Fe/kg BW,respectively)during postnatal days 2-14,while the Ctrl group was gavaged with saline.Results showed that FePP supplementation was as effective as FeSO4 in promoting growth,alleviating anemia and restoring body iron levels.Both low and high doses of FePP could significantly down-regulate the expression of pro inflammatory cytokines in the colon to the level similar to that in the Ctrl group(P>0.05).However,the high dose of FeSO4 did not show a down-regulation effect.Compared with the Ctrl group,IDA caused a disturbance of gut microbiota composition in suckling rats,and FePP could restore this dysbiosis.Besides,FePP was more beneficial than FeSO4 in increasing the abundance of beneficial bacteria such as Bacteroides and Akkermansia.Spearman’s correlation analysis showed a correlation between gut microbiota and biochemical indicators such as iron status,pro-inflammatory cytokine expression,and oxidative stress level.Overall,these findings suggested that FePP could effectively improve IDA,and is more effective than FeSO4 in alleviating intestinal inflammation and regulating gut microbiota,which provides a basis for the application of new iron fortificant in infant formula.
文摘Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),which is responsible for coronavirus disease 2019(COVID-19),has infected>700 million people and led to>7 million deaths worldwide.Although COVID-19 primarily affects the lungs,it can also affect the kidneys through various pathways.SARS-CoV-2 affects the kidney via several common mechanisms,such as dysregulation of angiotensin-converting enzyme 2,transmembrane serine protease 2 and tissue proteinase L expression in kidney tissue.People with chronic kidney disease(CKD)and COVID-19 have an increased risk of mortality and hospitalization in the intensive care unit.Anemia,a common consequence of CKD,is also associated with worsening outcomes in COVID-19 patients.In these patients with multiple comorbidities,there is a sharp increase in D-dimers,inflammatory parameters,creatinine and blood urea nitrogen.COVID-19 patients also present with resis-tance to erythropoietin(EPO)-stimulating agents,which necessitates elevated dosages even several months post-infection.In CKD,anemia is exacerbated by decreased EPO production,red blood cell(RBC)fragmentation due to impairment of the renovascular endothelium in situations such as glomerulopathy and mali-gnant hypertension.Other factors include iron and/or folic acid deficiency,bleeding due to platelet dysfunction,inflammation,reduced RBC lifespan,poor iron utilization,uremia,and atypical blood loss after dialysis.Excessive hepcidin synthesis impairs the absorption of dietary iron and the mobilization of iron from endogenous reserves,thus contributing significantly to anemia and poor iron regulation in CKD.These findings suggest that CKD may contribute to the occurrence of anemia in COVID-19 patients,especially in older people with comorbidities.Our review aims to explore the complex relationship between CKD,COVID-19 and anemia to improve our understanding of the underlying mechanisms of the disease and the potential cofactors that worsen outcomes in these patients.
基金supported by the Provincial Natural Science Foundation of Hunan Province (2024JJ5603)。
文摘Microscopic polyangiitis (MPA) is an autoimmune disorder characterized by pulmonary capillaritis and necrotizing glomerulonephritis triggered by the deposition of oligoimmune complexes.This condition primarily aff ects the lungs and kidneys.^([1])The key pathological features in the lungs associated with MPA include pulmonary interstitial fibrosis and diffuse alveolar hemorrhage (DAH),which clinically present as cough,sputum production,hemoptysis,and dyspnea.[2] In this report,we present a patient with MPA complicated by severe anemia and DAH,notably without the typical symptoms of hemoptysis.
文摘Objective: To analyze the effectiveness of blood test indicators in the differential diagnosis of anemia. Methods: Sixty patients diagnosed with anemia (disease group) from June 2021 to June 2024 were selected. Based on the type of disease, the group was subdivided into iron deficiency anemia (IDA) with 31 cases, hemolytic anemia (HA) with 11 cases, and aplastic anemia (AA) with 18 cases. Based on the severity of the disease, the group was divided into mild anemia (30 cases), moderate anemia (19 cases), and severe anemia (11 cases). Sixty healthy individuals (control group) were also included, and all underwent blood tests. Comparisons were made between the red blood cell (RBC) indicators of the disease group and the control group, the blood test indicators of different types of anemia, and the serum iron levels of varying severity of anemia. Results: Except for red cell distribution width (RDW), the RBC indicators in the disease group were lower than those in the control group (P < 0.05). Comparisons of RBC indicators among different types of anemia showed significant differences (P < 0.05). Serum iron levels varied significantly among different degrees of anemia severity (P < 0.05). Conclusion: Blood tests can detect anemia, distinguish types of anemia, and assess anemia severity, offering high diagnostic value.
文摘BACKGROUND Gastrointestinal stromal tumors(GISTs)are caused by mutations in the KIT and platelet derived growth factor receptor alpha genes in approximately 90%of cases.A minority of wild-type GISTs are associated with neurofibromatosis type 1(NF1),an autosomal dominant genetic disease resulting from pathogenic mutations in the NF1 gene,which encodes the neurofibromin protein.NF1 patients often exhibit multi-system involvement,with café-au-lait macules and neurofibromas being characteristic symptoms.GISTs are a rare complication of NF1,with the tumors most frequently occurring in the small intestine(90%of cases),while occurrences in the stomach are rare.CASE SUMMARY A 51-year-old woman presented to the emergency department with complaints of dizziness,fatigue,chest tightness,and dark stools.Initial examination revealed a red blood cell count of 1.99×1012/L and a hemoglobin level of 43 g/L.She underwent blood transfusions and fluid replacement to stabilize her condition.Further investigations identified typical café-au-lait macules on her trunk,limbs,and face,along with neurofibromas.Endoscopy showed coffee-colored fluid in the gastric cavity,a large submucosal elevation with an exudative covering,and ulcer formation on the gastric fundus.Exploratory laparoscopy confirmed the tumor’s origin in the gastric fundus,and resection of the giant GIST was performed.Pathological analysis revealed a necrotic GIST measuring 18 cm×14 cm,classified as high-risk,with approximately 5 mitotic figures per 10 high-power fields and no tumor at the margins.Immunohistochemistry results were CD117(+),delay of germination 1(+),CD34(+),and succinate dehydrogenase complex iron sulfur subunit B intact expression.Genetic testing using next-generation sequencing confirmed an NF1 gene mutation.The patient underwent successful tumor resection and was discharged home with postoperative regorafenib therapy.A follow-up at one year showed no recurrence.CONCLUSION Given the diversity of clinical symptoms associated with NF1 and the complexity of NF1-related GISTs,surgical resection with complete tumor removal remains the preferred treatment option.However,the absence of a standardized treatment protocol for adjuvant therapy presents numerous challenges for clinicians.
基金Supported by Zhejiang Province Traditional Chinese Medicine Science and Technology Plan Project:Research on the Mechanism of Shisiwei Jianzhong Decoction in Treating Non-severe Aplastic Anemia with Kidney Yang Deficiency Based on the C Vactivated T Nuclear Factor(NFATc4)(2020ZB086)Zhejiang Province Traditional Chinese Medicine Science and Technology Youth Talent Plan Project:Study on the Academic thought and Clinical Application of Professor Zhou Yuhong in the Treatment of Chronic Aplastic Anemia(2021ZQ029)。
文摘OBJECTIVE:To investigate the effect of Shisiwei Jianzhong decoction(十四味建中汤,SJD)on non-severe aplastic anemia(NSAA).METHODS:Bone marrow mesenchymal stem cells(BMSCs)were isolated from bone marrow samples of 15 NSAA patients and 3 healthy controls.Cells were treated with gradient concentrations of SJD,and a portion was transfected with a vector overexpressing the nuclear factor of activated T cells,cytoplasmic 4(NFATC4).Cell viability and apoptosis were detected by cell counting kit-8 and flow cytometry,respectively.After adipogenic differentiation induction,lipid droplet formation in BMSCs was examined by Oil Red O staining.The expression of NFATC4,peroxisome proliferator-activated receptor gamma(PPARG),fatty acid-binding protein 4(FABP4),peroxisome proliferator-activated receptor-gamma coactivator(PGC-1α),and acetylated PGC-1αwas measured by quantitative real-time polymerase chain reaction or Western blot.RESULTS:SJD significantly increased the viability and decreased the apoptosis of NSAA-derived BMSCs.It also dose-dependently inhibited lipid droplet formation and decreased the expression of PPARG and FABP4 in NSAA-derived BMSCs.NFATC4 expression was higher in patients with NSAA than in healthy controls,and SJD downregulated its expression.NFATC4 overexpression reversed the inhibitory effect of SJD on adipogenic differentiation.Additionally,SJD promoted the deacetylation of PGC-1αin NSAA-derived BMSCs,which was also partially eliminated by NFATC4 overexpression.CONCLUSIONS:SJD inhibits adipogenic differentiation of BMSCs through downregulating NFATC4,thereby contributing to the remission of NSAA.
文摘To investigate the efficacy of a structured continuous nursing intervention program on clinical outcomes,self-efficacy,and sleep quality in patients diagnosed with aplastic anemia(AA).Methods:This study was a single-center,parallel-group,randomized controlled trial.A total of 64 patients with AA,treated at our hospital’s hematology department from May 2022 to May 2025,were enrolled.Participants were randomly allocated in a 1:1 ratio to either the control group(n=32),receiving routine nursing care,or the intervention group(n=32),receiving a six-month continuous nursing intervention program in addition to routine care.The intervention program consisted of structured health education,individualized psychological support,regular telephone follow-ups,and a 24/7 online communication platform.The primary outcome was the change in the Pittsburgh Sleep Quality Index(PSQI)score from baseline to six months.Secondary outcomes included hematological parameters(hemoglobin[Hb],absolute neutrophil count[ANC],platelet count[PLT]),incidence of adverse events(infections,bleeding episodes),quality of life(assessed by the Functional Assessment of Cancer Therapy–Anemia[FACT-An]),and self-efficacy(assessed by the General Self-Efficacy Scale[GSE]).Statistical analyses were performed using independent t-tests,and chi-square tests or Fisher’s exact tests as appropriate.Results:A total of 55 patients(28 in the intervention group and 27 in the control group)completed the study.At baseline,there were no statistically significant differences in demographic data,clinical characteristics,or outcome measures between the two groups(p>0.05).After six months,the mean PSQI score in the intervention group was significantly lower than that in the control group(7.12±2.05 vs.13.49±2.88;t=−13.450;p<0.001).The intervention group also demonstrated a significantly lower incidence of infections(4/28,14.29%vs.10/27,37.04%;p=0.048)and bleeding episodes requiring intervention(3/28,10.71%vs.9/27,33.33%;p=0.042).Furthermore,patients in the intervention group reported significantly higher scores on the FACT-An(125.70±10.31 vs.109.44±12.10;t=7.934;p<0.001)and the GSE scale(29.82±4.11 vs.23.51±4.80;t=7.311;p<0.001).While hematological parameters showed a trend toward improvement in the intervention group,the differences were not statistically significant compared to the control group(p>0.05).Conclusion:The implementation of a structured continuous nursing intervention program can significantly improve sleep quality,reduce the incidence of complications,and enhance quality of life and self-efficacy in patients with aplastic anemia.This evidence-based model of care should be considered for integration into standard clinical practice for the long-term management of this patient population.
文摘Anemia is a common yet often overlooked complication in patients with type 2 diabetes mellitus(T2DM),particularly those with chronic kidney disease.It significantly impacts patients'quality of life,cardiovascular health,and treatment outcomes.Despite its high prevalence,current clinical guidelines lack specific recommendations for anemia prevention and management in T2DM,especially in the context of newer antidiabetic therapies.This review explores the potential of emerging antidiabetic medications,such as sodium-glucose cotransporter-2 inhibitors,glucagon-like peptide-1 receptor agonists(GLP-1 RAs),and combined GLP-1-RA/GIP to mitigate anemia risk.Early detection and management of anemia in T2DM patients are crucial for improving glycemic control,reducing cardiovascular morbidity,and enhancing overall treatment outcomes.This review underscores the need for further research to better understand the mechanisms by which these novel therapies influence anemia risk and to integrate these findings into clinical practice.
基金National Natural Science Foundation of China,No.81890992.
文摘BACKGROUND Congenital sideroblastic anemia(CSA)is a rare and heterogeneous group of genetic disorders.Conventional treatment include pyridoxine(vitamin B6)and allogeneic hematopoietic stem cell transplantation(allo-HSCT),and can alleviate anemia in the majority of cases.Nevertheless,some CSA cases remain unresponsive to pyridoxine or are unable to undergo allo-HSCT.Novel management approaches is necessary to be developed.To explore the response of luspatercept in treating congenital sideroblastic anemia.CASE SUMMARY We share our experience in luspatercept in a 4-year-old male patient with CSA.Luspatercept was administered subcutaneously at doses of 1.0 mg/kg/dose to 1.25 mg/kg/dose every 3 wk,three consecutive doses,evaluating the hematological response.Luspatercept leading to a significant improvement in the patient's anemia.The median hemoglobin during the overall treatment with three doses of luspatercept was 90(75-101)g/L,the median absolute reticulocyte count was 0.0593(0.0277-0.1030)×10^(12)/L,the median serum ferritin was 304.3(234.4-399)ng/mL,and the median lifespan of mature red blood cells was 80(57-92)days.Notably,no adverse reactions,such as headaches,dizziness,vomiting,joint pain,or back pain,were observed during the treatment period.CONCLUSION We believe that luspatercept might emerge as a viable therapeutic option for the maintenance treatment of CSA or as a bridging treatment option before hematopoietic stem cell transplantation.
文摘BACKGROUND Exertional heat stroke(EHS)is a critical condition arising from prolonged physical exertion in high temperatures that typically presents with normal hemoglobin levels.However,atypical presentations can also occur,leading to significant complications such as hemolytic anemia and organ dysfunction.CASE SUMMARY This case report describes a male patient who experienced moderate-to-severe anemia that was difficult to correct,with a confirmed diagnosis of microangiopathic hemolytic anemia accompanying multiple organ dysfunction syndrome,indicative of critical EHS.Despite intensive resuscitation efforts,the patient’s condition deteriorated,necessitating admission to the intensive care unit for advanced management.CONCLUSION This case highlights the importance of recognizing atypical presentations of EHS,particularly that with significant hemolytic anemia and concurrent organ failure.Clinicians should maintain a high level of suspicion for these complications in patients displaying symptoms of heat-related illness,especially when caused by strenuous activity,as early diagnosis and intervention are crucial to improve patient outcomes.
文摘Iron deficiency anemia(IDA)continues to be a global public health problem.Oral iron is the universally accepted first-line therapy,and most children have a prompt and favorable response to oral formulations.In subsets of children who fail to respond due to intolerance,poor adherence,or inadequate intestinal absorption,parenteral iron is indicated.Despite numerous studies in adults with IDA of diverse etiologies,pediatric studies on parenteral iron use are very limited.Although mostly retrospective and small,these studies have documented the efficacy and safety profile of intravenous iron formulations.In this editorial the author comments on the most important published data and underscores the need to seriously consider parenteral iron use in children unresponsive to oral therapy.
