Recombinant erythropoietin and blood transfusions in cancer chemotherapy-induced anemia

BACKGROUND: We examined the relationship between religious attendance, religious affiliation, and use of acute hospital services by older medical patients. METHODS: Religious affiliation (n = 542) and church attendance (n = 455) were examined in a consecutive sample of medical patients aged 60 or older admitted to Duke University Medical Center. Information on use of acute hospital services during the year before admission and length of the current hospital stay was collected. Frequency of church attendance and religious affiliation were examined as predictors of hospital service use, controlling for age, sex, race, education, social support, depressive symptoms, physical functioning, and severity of medical illness as covariates using logistic regression. RESULTS: Patients who attended church weekly or more often were significantly less likely in the previous year to have been admitted to the hospital, had fewer hospital admissions, and spent fewer days in the hospital than those attending less often; these associations retained their significance after controlling for covariates. Patients unaffiliated with a religious community, while not using more acute hospital services in the year before admission, had significantly longer index hospital stays than those affiliated. Unaffiliated patients spent an average of 25 days in the hospital, compared with 11 days for affiliated patients; this association strengthened when physical health and other covariates were controlled. CONCLUSIONS: Participation in and affiliation with a religious community is associated with lower use of hospital services by medically ill older adults, a population of high users of health care services. Possible reasons for this association and its implications are discussed.     

Effect of anemia on blood and tissue lead in rats

The effect of anemia on the lead content of blood, red cells, and tissue was studied in rats given oral lead, 54 mg/kg-day for 6 days. The 16 rats made anemic (hematocrit, 26%) by bleeding on days 1, 3, and 5 had significantly higher concentrations of lead in the kidney, liver, red cells, blood, and brain (but not in the bone marrow). Increases in blood lead in anemic subjects were correlated with the concentrations in red cells, kidney, and liver. The greater increase in the lead content of all tissues of the anemic rats is consistent with increased lead absorption in anemia and is considered relevant to the clinical coexistence of anemia and lead poisoning.     

Cyanate-induced cataracts in patients with sickle-cell hemoglobinopathies

Two young patients developed bilateral posterior subcapsular cataracts while receiving oral sodium cyanate for treatment of sickle cell hemoglobinopathy. In one of the patients, lens opacities regressed spontaneously after cyanate therapy was discontinued.     

Longitudinal studies of blood pressure in children

A longitudinal study of six years was conducted to find out the pattern of longitudinal changes of blood pressure and to affirm the "tracking phenomenon" of blood pressure in children in China. We initially measured blood pressure and related parameters of 2,946 children (aged 4-14 years) in 1981 at Fanshan county, Beijing, and then two follow-up remeasurements were conducted in 1985 and 1987, respectively. The results indicated that: the average level of blood pressure increases with age even after adjusting for height and weight; tracking coefficients of systolic blood pressure range from weak to moderate levels, increasing with age. Only 30% of the children whose systolic blood pressure was beyond the 90th percentile of the systolic pressure distribution at the first examination remained at the same region after four years. Multiple stepwise regression was used to determine factors correlated with blood pressure. Our results indicate that systolic blood pressure in children is correlated with body weight, pulse rate, serum glucose and HDL-C, while diastolic blood pressure is correlated only with pulse rate and serum glucose.     

Natural changes in the indices of cardiohemodynamics in iron-deficiency anemia and blood loss in labor]

Appalachia is usually written about in romantic terms; rarely are the citizens of Appalachia portrayed as contributors to society. Appalachia is made up of many cultures--African American, European American, Melungeon, Native American and others. Appalachian cultures are not locked in a fixed state; one needs only to review the history of Appalachia to understand this concept (Tice & Billings, 1991). Appalachian cultures are fluid and ever-changing. The cultures are expressed in literature, oral histories, music and regional history.     

Diagnosis of sickle-cell disease by DNA analysis in Nigeria

OBJECTIVE: To compare genotyping of leucocyte DNA by PCR and Dde I with the conventional genotyping of haemoglobin of the same subject. DESIGN: Comparative study. SUBJECTS: 25 adults, 16 males and nine females. MAIN OUTCOME MEASURES: Predictability. RESULTS: In all cases the results were comparable. CONCLUSIONS: The technology can be applied locally to prenatal diagnosis of sickle-cell disease by chorionic sampling and, therefore, improve the management of sickle-cell disease in Nigeria.     

Free energy simulations of axial contacts in sickle-cell hemoglobin

Molecular dynamics simulations have been used to investigate the thermodynamic stability of axial contacts in sickle-cell hemoglobin (HbS). Free energy changes were evaluated for the point mutation beta 121 Glu --> Gln in the axial contact region of HbS crystals. The calculations predict a free energy change of-3.6 kcal/mol per contact for the mutation, which is in qualitative agreement with experimental observations of aggravated sickling found in the double mutant Hb D Los Angeles (beta 6 Glu --> Val. beta 121 Glu --> Gln) relative to HbS (beta 6 Glu --> Val). The beta 121 Glu is sequestered in a salt link with beta 17 Lys located on the same polypeptide chain, making the Glu interactions with its surroundings similar in aggregates and individual hemoglobins. Due to this cancellation of the large electrostatic Glu contributions, the weak nonspecific interactions between the Gln and the neighboring polypeptide chain are the main contributing factor to the enhanced aggregation of Hb D Los Angeles relative to HbS. Together with the previous study of the lateral contact [K. Kuczera et al. (1990) Proceedings of the National Academy of Science USA, Vol. 87, pp, 8481-8485], the present results provide a more complete picture of the forces driving the sickling aggregation. A comparison of different treatments of internal flexibility in free energy simulations and analysis of rate of convergence of the different calculated properties has also been performed.     

The erythrocyte lipids of the peripheral blood and myocardial dystrophy in patients with iron-deficiency anemia

Lipids of peripheral blood red cells (total lipids and phospholipids, triglycerides, free fatty acids, cholesterol, cholesterol ethers, lysophospholipids, sphingomyelins, phosphatidylserins, phosphatidylethanolamines, phosphatidylcholines, cardiolipins, phosphatid acids) were assessed in correlation with wave T height on resting ECG. It is shown that iron deficiency anemia patients develop shifts in red blood cell lipid composition contributing to the onset of myocardiodystrophy. The correction of the lipid composition defects is an additional factor decreasing dystrophic processes in the myocardium.     

Creatine content in erythrocytes and blood plasma of chickens before and following stimulation of erythropoiesis by anemia

The red blood cells of chicken have a lower creatine concentration than those of man (1 mg/100 ml vs 5-6 mg/100 ml cells). No creatine phosphate was found in either erythrocytes or reticulocytes. With anemia produced by phenylhydrazine and bleeding a young cell population appeared with a higher creatine concentration.     

Cardiac surgery using cardiopulmonary bypass in a patient with sickle-cell trait

The sickle-cell gene is most concentrated in West Central Africa, the northeast corner of Saudi Arabia and East Central India. Sickle cell trait is the heterozygous condition for Hb S gene. Thirty to fifty per cent of their hemoglobin is Hb S and the remainder is Hb A. The sickle-cell crisis is induced by hypoxia, hypercarbia, acidosis, low flow condition, and hypothermia, which leads to vasoocclusion. A 39-year-old black man from Burkina Faso located in West Africa with left ventricular rupture was admitted for operation using cardiopulmonary bypass (CPB). He had been diagnosed as sickle-cell trait. The Hb S concentration was 36.2 per cent before operation with hemoglobin electrophoresis. During CPB, the minimum blood temperature was 31 degrees C and an aortic cross-clamp was not done. Total CPB time was 1 hour 31 minutes. Use of vasodilator and hyperventilation was effective. No neurological sequelae were observed.     

Cord blood gas studies: a survey

A 51-year-old black female with sarcoidosis diagnosed 20 yr earlier developed massive chyloperitoneum and chylothorax. Autopsy demonstrated fibrotic and enlarged thoracic and mesenteric lymph nodes. Sarcoidosis can produce chyloperitoneum by producing intrathoracic nodal fibrosis and lymphatic obstruction.     

Is there a correlation between raised erythropoietin and thrombotic events in sickle-cell anaemia?

Children with sickle-cell anaemia are predisposed to thrombotic strokes, the aetiology of which is unclear. We propose that erythropoietin, produced in response to chronic anaemia, is responsible for changes in platelet reactivity with a resulting increase in thromboses. This hypothesis is based on reports of enhanced aggregability of erythropoietin-driven platelets and an increased rate of thrombosis in patients receiving large doses of recombinant erythropoietin. Experiments in animals have shown that erythropoietin stimulates synthesis of platelets, that erythropoietin-driven platelets are hyper-reactive compared with age-matched control platelets, and that erythropoietin is pro-thrombotic. These data suggest that erythropoietin-dependent changes in platelet reactivity may potentiate thrombosis in sickle-cell anaemia, particularly in children who, compared with adults, have markedly higher erythropoietin concentrations and incidence of strokes.     

Colony growth in cultures from bone marrow and peripheral blood after curative treatment for leukemia and severe aplastic anemia

The recovery of colony-forming cell numbers after curative treatment for leukemia and severe aplastic anemia (SAA) was studied. We examined 191 patients (85 acute myeloid leukemia [AML], 48 acute lymphocytic leukemia [ALL], 32 chronic myeloid leukemia [CML], 17 SAA, and nine myelodysplastic syndrome [MDS]) who were in hematologic remission 6 months to 13 years after either curative chemotherapy (n = 69) or allogeneic bone marrow transplantation (BMT) (n = 122) by culturing their precursor cells from bone marrow (BM) (n = 548) and peripheral blood (PB) (n = 529) in methylcellulose. Thirty-six BM donors and 25 PB donors served as controls. BM colony-forming cell numbers were abnormally low in all patients (p < 0.002) irrespective of underlying disorder and type of treatment (chemotherapy or irradiation). These numbers did not normalize with time--colony-forming cells were still strongly reduced up to 10 years after therapy, whether or not the patient had received an allogeneic bone marrow graft (p < 0.002). We also compared patients who remained in stable hematologic remission with those who later relapsed (6 months to 2 years after treatment). BM colony-forming cell numbers were significantly lower in patients who subsequently relapsed (p = 0.004). In contrast to BM cultures, we found normal colony-forming capacity by PB precursors in all patients. We conclude that (1) after chemotherapy or BMT, colony-forming cell numbers of BM in culture are permanently reduced; (2) this defect is probably due to a dysfunction of the BM environment rather than to a numerical reduction of the precursor cell pool; and (3) very low colony-forming capacity may be related to relapse.