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Challenges and Opportunities in Anemia

Challenges and Opportunities in Anemia

Mocket Adolphe Ehouman, Kouakou Eliezer Ngoran, Rufin Kouassi Assare, Ahossan Andre Ehouman, Pamela Nassinata Dosso, and Cyrille K. Konan


Background: Anaemia is serious public health problem affecting nearly 42% of children less than 5 years of age globally. In Cote d`Ivoire, 72% of the children aged 6-59 months were anemic in 2019. Anemia is defined as a reduction in the hemoglobin level in the peripheral blood below the normal threshold set for a particular population. Very commonly in the subtropics, helminthes, protozoans or malaria co-infects the same person, causing morbidities that vary according to age and region. This research study aims to characterize the type of anemia observed in 6 years old children infected with helminthes and protozoans in the Western part of Côte d`Ivoire, in order to improve the recommended strategy of care.

Methods: The study was carried out from March 2020 to May 2021 in 22 villages of Biankouma and Man, in Tonkpi Region, with a cohort of 451 children, both male and female, aged from 3 months to 6 years. The children provided venous blood samples for the diagnosis and characterization of anemia (full blood count), urines and stool samples were used for the diagnosis of helminthiasis and protozoosis. Univariate analysis (Chi-2 test (χ2) and P: (Probability) were used for comparison between groups. Significant test was considered at a threshold of 0.05.

Results: Of the 451 children who completed the study, 221 (49.0%) were female and 230 (51.0%) were male. Helminthes infections (230, 51.0%) were more prevalent than the protozoans’ infections (40, 8.9%). 50.0% of children infected by intestinal helminthes (S. mansoni) were anemics (33.9% mild, 64.4% moderate and 1.7% severe). The characterization of anemia revealed that hypochromic microcytic anemia (HMA) was the predominant type, being found in 87 (74.8%) children. It was followed by normochromic microcytic anemia (12 children, 10.4%), normochromic normocytic anemia (09 children, 7.8%), and, finally, hypochromic normocytic anemia (08 children, 7.0%).

Conclusion: S. mansoni infection was highly prevalent among 6 years old children in both sex and in different age groups, although the number of helminthes parasites present during infections was greatest in older children. Similarly, the prevalence of anemia was high, with moderate anemia and HMA being more prevalent in 6 years old children in the western region of Côte d’Ivoire.

Esa Soppi, MD, PhD,


Iron deficiency in absence of anemia and blood count changes is a common disorder. Since iron is an essential cofactor not only of hemoglobin and myoglobin but also of numerous enzymes fundamental for many biological processes, it is understandable that the spectrum of iron deficiency related symptoms may be complex, severe and difficult to associate with iron deficiency. This often leads to significant diagnostic delays and a multitude of misleading diagnoses and treatments. Therefore, considering a diagnosis of iron deficiency without anemia requires a high degree of alertness. The second step in the diagnostic process, following consideration of the possibility of iron deficiency, is a careful history that covers all potential causes of deficient iron stores since the patient’s birth and beyond combined by the appropriate investigations. The ferritin concentration is key for ascertaining the diagnosis. A ferritin concentration of less than 30 µg/L in a symptomatic individual means iron deficiency, but the patient may be iron deficient with much higher ferritin concentrations. Simultaneous determination of C-reactive protein with ferritin is practically useless. The treating physician should be familiar with the complexity of ferritin determinations and the interpretation of the results. The mainstay of treatment is oral iron but a considerable proportion of patients are intolerant or insufficiently responsive to oral iron and require intravenous iron therapy. The longer the duration of the iron deficiency, the more complicated the treatment and the patient’s recovery may become. For some patients, iron deficiency seems to be a chronic disorder requiring management exceeding 5 years. In 1–5% of patients, particularly those with a duration of iron deficiency in absence of anemia of more than 15–25 years, the restoration of iron stores does not lead to clinical recovery within 5 years of follow-up. Iron deficiency without anemia has a high impact on the well-being and quality of life of the affected individuals and impacts significantly also on society, since the challenges in recognition, diagnosis and treatment of the condition generate costs probably in excess of 100 million euros/5 million inhabitants.

Dhanya Mohan, Amna Khalifa Alhadari, Dileep Kumar, Sima Abdolla Nejad, Rahaf Mohamad Wardeh, Batool Khan, Madheeha Mahmood, Zuha Fathima, and Mohammed Railey


Cryoglobulinemic vasculitis presents with systemic vasculitis including vasculitic rash, fever, peripheral neuropathy, and, in rare cases renal involvement. This could be secondary to infections like hepatitis C, malignancies like myeloma, Non Hodgkin’s lymphoma and chronic lymphocytic leukemia. We encountered a patient who presented with fever, anemia, purpuric skin rash and acute kidney injury due to acute glomerulonephritis with nephritic picture and fluid overload that required hemodialysis.Investigations revealed hemolytic anemia, cryoglobulinemia, proliferative glomerulonephritis with Ig M intra-capillary deposits and hyaline thrombi. Bone marrow biopsy clinched the diagnosis of Chronic lymphocytic B cell lymphoma with CD 20 positivity. Treatment was instituted with Rituximab and Bendamustine. Plasmapheresis was done for hyperviscosity syndrome. With treatment, hemodialysis could be discontinued after 10 weeks and renal functions recovered partially with serum creatinine settling at 1.5 mg/dl. We present this case to highlight the presentation of chronic lymphocytic leukemia with cryoglobulinemic vasculitis that presented with purpura and rapidly progressive renal failure that required dialysis.

Evelim Leal de Freitas Dantas Gomes, Dr., Carolina Cristina Santos Camargo, Debora Nunes Prata Anjos, Etiene Farah Teixeira de Carvalho


Onco-hematological diseases are serious conditions and often require aggressive treatment that can lead to systemic complications, consequently affecting musculoskeletal functions as well as physical and functional capacity. Respiratory complications can lead to a greater frequency of hospitalizations and immobility, creating a cycle of sedentarism as well as an increase in morbidity and mortality. The goal of physical therapy in such cases is to restore compromised functions in affected children and adolescents and ensure the performance of activities of daily living and better development.The aim of this review was to bring to light the dysfunctions promoted by onco-hematological diseases of childhood in order to understand the best way to approach the treatment for this population.In this review, the functional alterations of sickle cell anemia, leukemia and bone marrow transplantation were addressed, as well as the interventions used by physiotherapy for the treatment.

Pétur Sigurjónsson, MD Msc., Asta Dogg Jonasdottir, MD Msc., Ingvar H Olafsson, MD, Sigurbergur Karason, MD, PhD, professor, Gudmundur Sigthorsson, MD Msc PhD, and Helga A Sigurjonsdottir, MD, PhD, professor


Background and aims of the study: Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) can cause death and long-term morbidity. Studies indicate that both TBI and SAH may affect pituitary function in both the acute and the chronic phase. The aims of this study were firstly to evaluate the nature of neuroendocrine changes in the acute phase of moderate and severe TBI and all SAH, to evaluate association between neuroendocrine disturbance and indicators of severity of insult as well as hypotension, desaturation and anemia and to evaluated the incidence of neuroendocrine changes after moderate and severe TBI and SAH in the acute phase. Purpose: To explore neuroendocrine disturbances in moderate traumatic brain injury (mTBI), severe TBI (sTBI) and subarachnoid hemorrhage (SAH) in the acute phase.

Methods: The study was a prospective single-center study. Anterior hypothalamic-pituitary (HP) hormone axis were assessed on admission (day 0) with baseline hormone levels and on day 6 post insult with baseline hormone levels and a Synacthen test. From patient charts we recorded for all patients GCS, APACHEII score, length of ICU stay, pupil dilatation, documented hypotension, desaturation and hemoglobin value <80 g/dL. Hunt and Hess grade for SAH group and Injury severity score for TBI group. S100b was measured in all patients on admission. We included 21 TBI patient, 6 moderate TBI and 15 severe TBI, and 19 SAH patients. Anterior hypothalamic-pituitary (HP) hormone axis were assessed on day 0 and 6 post insult in Twenty-one TBI patient and 19 SAH patients.

Results: HP-adrenal axis: The TBI group had significantly lower mean cortisol than the SAH group on day 0, 23.8% of TBI patients had low cortisol and 0% of SAH patients. On day 6, one patient in each group had low cortisol, 6.7% of TBI and 9.1% of SAH. HP-gonadal axis: In males on day 0, 52.9% of TBI patients and 57.1% of SAH patients had suppressed HP-gonadal axis and on day 6, 84.6% of TBI patients and 90% of SAH patients. There was a greater suppression of LH/FSH in the TBI group. HP-thyroid axis: Only one TBI patient (5.9%) had secondary hypothyroidism on day 6. HP-somatotroph axis: On day 0, 52.4% of TBI patients and 35.7% of SAH patients had low IGF-1. On day 6 all but one TBI patient (5.9%) had normalized their IGF-1 but 25% of SAH patients still had low IGF-1. In general, when evaluating association there seemed to more suppression of the hypothalamic-pituitary (HP) gonadal and thyroid axis with more severe insult and adequately more activation of the hypothalamic-pituitary adrenal axis.

Conclusion: Neuroendocrine disturbances in the acute phase of TBI and SAH are common and seem to differ between the two groups. The clinical significance of these disturbances is uncertain.



Background: Plasma cell gingivostomatitis belongs to a group of uncommon benign inflammatory conditions characterised by macular lesions that are bright red, velvety, sharply circumscribed, flat to slightly elevated in nature. Intra-oral lesions can manifest as dense band-like gingival enlargements with plasma-cystic infiltrate seen in the histo-pathological sections. The present case report highlights findings of atypical plasma cell gingivostomatitis further managed through clinical, radiological, histopathology, immunohistochemistry, hematological analysis and treated with surgical periodontal therapy.

Method: Intra-oral periodontal parameters were assessed followed by non-surgical periodontal therapy. In the later phase, internal bevel gingivectomy carried out and  approximated with interrupted sutures. Furthermore, gingivoplasty with a 810nm diode laser, for better adaptation of gingival margins was performed. The patient was recalled for follow-up visits at regular intervals and results were maintained.

Result: Intra-oral histopathological sections revealed plasma cell gingivitis whereas hematological reports were suggestive of anemia. Gradual follow up showed reduced gingival inflammation. Post-surgical wound healing was satisfactory. Disappearance of extraoral induration was highlighting feature in the post-operative phase.Further patient was recalled for follow-up visits at regular intervals and results were found to be maintained.

Conclusion: The overall gingival condition was seen to be improving at the follow-up visits. The authors thus conclude that the case of plasma cell gingivitis treated by comprehensive periodontal therapy showed satisfactory results at 3 years follow-up and no recurrence in extra-oral findings was noted.

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