Anemia status, hemoglobin concentration and outcome after acute stroke: a cohort study
The goal of this study was to determine whether hyperglycemia, as reflected by GHb Erythrocyte survival was determined from the difference between the subjects' It is well accepted that glucose combines with Hb via a slow irreversible. The primary function of erythrocytes is the transport of oxygen to tissues. . Correlations of EPO, hematocrit and hemoglobin in relation to the level of RI .. K /DOQI Clinical Practice Guidelines for Chronic Kidney Disease. The relationship between hemoglobin quartiles and all-cause death revealed a Our aims were, therefore, to evaluate in a large cohort of patients .. loss, impaired red blood cell production, and/or increased red blood cell.
The relationship between the entire range of hemoglobin and outcome after stroke is not well understood. Given the relevance of hemoglobin to oxygen carrying capacity, inflammatory processes, oxidative stress, as well as to blood viscocity and cerebral blood flow, we hypothesized that extremes of both low and high hemoglobin are associated also with poor outcome in the setting of an acute stroke.
Our aims were, therefore, to evaluate in a large cohort of patients hospitalized for an acute stroke: Methods A prospective cohort study was conducted on consecutive patients hospitalized due to acute stroke in a large medical center with a catchment area of aboutpeople from March to June Baseline hemoglobin was missing in 24 patients, thus the final study cohort included patients.
Patients were evaluated systematically for risk factors, stroke severity, type and subtype. Risk factors were assessed from medical records and self-report. Intracerebral hemorrhage and ischemic stroke were differentiated by the results of the baseline head CT scan. Ischemic stroke etiology was determined by the TOAST classification, a system for categorization of subtypes of ischemic stroke mainly based on etiology that has been developed for the Trial of Org in Acute Stroke Treatment [ 12 ].
Anemia; Low hemoglobin, low hematocrit, low red cell count
A clinical evaluation and personal interview was performed after 1-months and a phone follow-up interview after 1-year, after obtaining informed consent. The study was approved by the local Institutional Review Board. The first hemoglobin measurement performed at hospital admission served as the index hemoglobin.
Outcomes of interest Outcomes were assessed during the first year after the stroke. One-year after the stroke, phone follow-up interviews were conducted by professional interviewers from the Israeli Center for Disease Control blinded to in-hospital data.
Mortality data were derived from the Israeli Population Registry. If possible, samples should be re-drawn by direct venipuncture. A similar artifact can arise when samples are drawn from a site that is proximal to an intravenous access site. In this case the clinical laboratory should report a "spun hematocrit" or "packed-cell volume".
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In many cases agglutination can be reversed by warming the blood sample prior to analysis. Cold agglutinins do not affect accuracy of spun hematocrit measurements. Abnormal proteins myeloma, cryofibrinogens can interfere with RBC analyses; spun hematocrit measurements are reliable under these conditions.
Consider complicating factors [fluid overload, cardiopulmonary compromise, religious objection, immune dysregulatory state hyperhemolysis, post-transfusion purpura ]. Transfusion goals may differ depending upon the degree and chronicity of the anemia, and the extent to which it compromises organ function.
Preferred route of administration. Goal is to provide - mg elemental iron per day. Concern for anaphylactic reactions; most formulations require a 'test' dose. Available as ferric gluconate test dose, followed by mg in ml saline infused over 30 - 60 minutes ; iron sucrose test dose, followed by mg over 60 minutes ; iron dextran test dose, followed by treatment dose.
One unit of transfused blood contains approximately mg of iron. The etiology of vitamin Bdeficient states should always be determined. Schedules for other agents vary widely depending upon the specific condition that is being treated and the patient's underlying medical condition; these pharmaceuticals include steroids and other immunosuppressive agents, intravenous immunoglobulins, replacement hormones, and chemotherapeutic agents.
Differences Between RBC And Hemoglobin | Difference Between | RBC And Hemoglobin
Refractory cases An attempt should be made to determine the nature of the underlying anemia blood loss, red cell destruction, marrow failure. For refractory cases, consider the possibility that the etiology of the anemia has evolved e.
Identify and treat any underlying disorders. Consult a hematological subspecialist to assist with diagnosis and management.
Disease monitoring, follow-up and disposition Several conditions can alter the half-life of both normal and transfused red blood cells.
The prognosis of an anemia is largely dictated by the prognosis of the corresponding underlying disorder.
The patient should be continually monitored and supportive care provided while disease-specific therapy is administered. Hct ratio that does not approximate 1: In all cases, laboratory tests should be repeated using samples that are drawn by direct venipuncture not through a vascular access line, and not proximal to an intravenous access site. Note that automated values for Hb can be affected by lipemia, icterus, cold agglutinin antibodies, and by some abnormal proteins myeloma, cryofibrinogens.
Spun hematocrit measurements are generally reliable under all of these conditions. In many cases the location of hemorrhage may be obvious--or easily deduced--from the patient's history and physical exam: Hemorrhagic anemia can be complicated by qualitative or quantitative platelet defects, and by congenital, acquired, or therapeutic changes in the quantity or activity of blood coagulation proteins.
Destructive Destructive defects can be broadly classified as inherited, mechanical, acquired non-immune, and acquired immune. These defects, which result in increased clearance of red cells through a number of different mechanisms, generally result in accelerated destruction of red blood cell progenitors in the marrow ineffective erythropoiesis and shortened half-life of mature erythrocytes in the peripheral circulation hemolysis.
As a group, these disorders are characterized by markers of hemolysis increased LDH and bilirubin, reduced haptoglobin with normal Coombs studies, as well as a compensatory elevation in erythropoiesis can manifest as a reticulocytosis.
Mechanical anemias of this type can be traced to defects in normal vascular flow by therapeutic devices artificial heart valves, extracorporeal circulationstructural defects aortic stenosis, renal artery stenosisor several conditions that result in microvascular occlusion.
This last group of disorders includes the microangiopathies, which are characterized by fragmented red cells schistocytesincluding DIC, TTP, HUS, eclampsia, carcinomatosis, allograft rejection, and malignant hypertension.
Non-immune conditions that result in red cell destruction include malaria, chemical agents that are directly toxic to red cells, and thermal injury burns.
Mechanisms Linking Red Blood Cell Disorders and Cardiovascular Diseases
Immune processes that cause red cell destruction typically result from the deposition of antibodies on the red cell membrane. The specific clinical manifestation may depend upon the antibody class: Red cells contain a special protein called hemoglobin, which helps carry oxygen from the lungs to the rest of the body and then returns carbon dioxide from the body to the lungs so it can be exhaled.
Blood appears red because of the large number of red blood cells, which get their color from the hemoglobin. The percentage of whole blood volume that is made up of red blood cells is called the hematocrit and is a common measure of red blood cell levels. They are much fewer in number than red blood cells, accounting for about 1 percent of your blood. The most common type of white blood cell is the neutrophil, which is the "immediate response" cell and accounts for 55 to 70 percent of the total white blood cell count.
Each neutrophil lives less than a day, so your bone marrow must constantly make new neutrophils to maintain protection against infection.
- Anemia status, hemoglobin concentration and outcome after acute stroke: a cohort study
- Transfusion of Blood and Blood Products: Indications and Complications
- Differences Between RBC And Hemoglobin
Transfusion of neutrophils is generally not effective since they do not remain in the body for very long. The other major type of white blood cell is a lymphocyte. There are two main populations of these cells.