Open Access Review Article

Iron Overload, Chelation Therapy and Survival in Lower-Risk Myelodysplastic Syndromes: State of the Evidence

Roger M. Lyons

International Blood Research & Reviews, Page 95-112
DOI: 10.9734/IBRR/2014/8580

Myelodysplastic syndromes (MDS) are clonal stem cell disorders that primarily affect older persons and are associated with peripheral blood cytopenias, increased risk of conversion to acute myeloid leukemia and shortened survival. Treatment strategies in MDS are guided by patient risk categories, with higher-risk patients receiving more aggressive interventions. Patients with lower-risk MDS receive less aggressive therapies or supportive care/red blood cell transfusion. Transfusion-dependent patients with lower-risk MDS are likely to develop iron overload because of their longer predicted survival and, hence, greater transfusion burden. Transfusion requirement and elevated serum ferritin further complicate the treatment landscape because they have dose-dependent effects on overall and leukemia-free survival, with increasing serum ferritin levels associated with increased risk of death. Lower iron burden could provide a survival benefit, and an association with improved survival has been shown in retrospective studies. However, lack of random assignment to treatment is the major flaw in these studies, which potentially introduces patient selection bias. Despite the lack of randomization and other issues with trial design, available studies have shown consistent results, which suggest a survival benefit in transfusion-dependent patients with MDS who have received chelation therapy. Prospective studies are needed to confirm this observation. The possible mechanisms by which chelation therapy appears to benefit patients with MDS need further research. The data suggesting a survival benefit from chelation therapy in lower-risk, iron-overloaded patients with MDS are reviewed, including the strength of evidence, recent scientific advances and ongoing clinical trials.

 

Open Access Original Research Article

Effect of Leaf Essential Oil of Citrus sinensis on Haematological Parameters of Alloxan-induced Diabetic Rats

O. Soji-Omoniwa, N. O. Muhammad, B. P. Omoniwa, L. A. Usman

International Blood Research & Reviews, Page 113-120
DOI: 10.9734/IBRR/2014/7952

Aim: The aim of this study was to investigate the effect of leaf essential oil of Citrus sinensis (Rutaceae) on haematological parameters of alloxan – induced diabetic rats.

Methodology: Diabetes was induced in albino rats by intraperitoneal administration of single dose of alloxan monohydrate (150 mg/kg body weight). The leaf essential oil of Citrus sinensis at a dose of 110 mg/kg b.wt was administered every other day to the diabetic rats during 15 days. The effects of leaf essential oil on the erythrocyte and leucocyte indices were then evaluated.

Results: Red Blood Cell, Packed Cell Volume, White blood cell, Neutrophils and Leucocytes were reduced significantly in diabetic animals. However, treatment with leaf oil of C. sinensis increased these parameters subsequently.

Conclusion: It is concluded that leaf essential oil of Citrus sinensis improved the erythrocyte and leucocyte indices of diabetic rats.

Open Access Original Research Article

Knowledge, Attitude and Practice of Blood Conservation Strategies amongst Physicians’ in Tertiary Hospitals

Ajibola Sarah, Akinbami Akinsegun, Odesanya Majeed, Dada Akinola Olusola

International Blood Research & Reviews, Page 121-131
DOI: 10.9734/IBRR/2014/8906

Aim: To assess the extent of available knowledge, as well as the attitudes and the utilization of blood conservation strategies amongst medical doctors, who are the implementers of blood transfusion and conservation in clinical practice.

Study Design: A cross-sectional study.

Place and Duration of Study: Clinical Departments in both Lagos State University Teaching Hospital, Lagos State and Babcock University Teaching Hospital, Ogun State between  August 2013 and November 2013.

Methodology: We included clinicians from various medical specialties in the study (78 from public hospital and 26 from private hospital). A pre-tested, self-administered questionnaire was devised to collect data. Data was entered and analyzed descriptively and qualitatively.

Result: A total of 104 doctors participated in the study consisting of 57 males (54.80%) and 47 females (45.29%). Almost all participants had transfused blood in their practice and all participants were aware that blood transfusions have complications. Majority 80 (76.9%) had heard about blood conservation techniques, about 51 (49%) had used any of the strategies.

 If available, 93 (89.4%) would use any of the strategies, only 1 (1%) would not.

Conclusion: There is a need for hospital transfusion committees to educate and increase the drive for utilization of blood conservation methods amongst doctors, so as to increase its practice.

 

Open Access Original Research Article

Some Blood Cell Changes and Alteration in Renal and Hepatic Function in Pre-eclampsia: A Study in Owerri Nigeria

Precious Nc. Alisi, F. I. Buseri, Chinwe S. Alisi

International Blood Research & Reviews, Page 132-139
DOI: 10.9734/IBRR/2014/3018

Aims: We studied some blood cell changes and alterations in renal and hepatic functions in pregnancy and pre-eclampsia and determined baselines for the population in owerri, south east Nigeria.

Study Design: It was a cross sectional case control study conducted prospectively among antenatal women attending clinic at Holy Rosary, Federal Medical Centre and General Hospitals Owerri. The study included fifty non-pregnant, fifty pre-elampsia and fifty normotensive pregnant women of singleton gestation in their third trimester

Place and Duration of Study: Sample: Antenatal unit of Holy Rosary, Federal Medical Centre and General Hospitals Owerri between May 2009 and June 2010.

Methodology: The study included fifty (50) non-pregnant women, fifty (50) pregnant normotensive women and fifty (50) pre-eclamptic women of singleton gestation in their third trimester. Full blood count, liver function enzymes assay and some kidney function parameters was determined in all subjects. The subjects were selected under defined criteria. PE patients were at 28 to 42 wks of single-diastolic pressure of 110mmHg or more or two measurements of 90mmHg or more on two consecutive occasions of 6hours or more apart, urinary protein 2+ or more. The exclusion criteria include history of hypertension and proteinuria before conception or before 20wks of gestation, a history of antioxidant vitamins therapy during the last one year and smoking.

Results: The result showed a significant (P = 0.05) decrease  in Red cell distribution width coefficient of variance (RDW-CV), mean cell haemoglobin (MCH),  platelet count (PC) and mean platelet volume- platelet count (MPV-PC) ratio in pre-eclampsia comaperd to normal pregnancy. Significant increases (P= 0.05) in red blood cell count, haemoglobin concentration, haematocrit, mean cell volume, mean platelet volume, platelet distribution width (PDW) and circulating large platelet ratio (PLCR) were found among the pre-eclamptic women. There was a significant (P = 0.05) increase in ALT, AST, ALP and LDH activities in pre-eclampsia when compared to both the normal and the pregnant controls. Urea, Creatinine and Uric acid concentrations had a significant increase (P = 0.05) in pre-eclampsia when compared to normal and pregnant controls

Conclusion: The significant variation seen in these red cell parameters between the PC and NPC is attributable mainly to pregnancy than to pre-eclampsia. Pre-eclampsia though resulted in a marked platelet usage with a resulting shorter platelet life-span. A burden on the liver and kidney resulting from pre-eclampsia could have adversely affected protein metabolism which in turn may have affected erythropoesis. Results indicate that renal function is impaired in the presence of pre-eclampsia.

 

Open Access Original Research Article

Prophylaxis with Low Molecular Weight Heparin for Prevention of Placenta-related Recurrent Adverse Pregnancy Outcomes

Joel H. Kamda, Alessandro Ghidini, John C. Pezzullo, Sarah H. Poggi

International Blood Research & Reviews, Page 140-148
DOI: 10.9734/IBRR/2014/9703

Aims: To determine whether antenatal administration of low-molecular-weight-heparin (LMWH) reduces the recurrence of adverse pregnancy outcomes (APO).

Study Design: Retrospective cohort study.

Place and Duration of the Study: Inova Alexandria Hospital, Alexandria, VA and Georgetown University Medical Center, Washington, DC during the period of January 1, 2006 and December 31, 2009.

Methodology: All pregnant women with history of APOs, including preeclampsia or abruption at <35 weeks, birth weight <5th centile, fetal loss at ≥20 weeks, or ≥2 spontaneous losses between 12 and 20 weeks, were administered LMWH or not at the discretion of the managing physician. Excluded were cases with antiphospholipid syndrome. The independent effect of LMWH on recurrence was assessed using logistic regression analysis with odds ratios (OR) having 95% confidence interval (CI) not inclusive of the unity considered significant.

Results: Of the 140 women in the cohort, 44 (31%) received LMWH during the subsequent pregnancy and the remainder did not. APO recurred in 23.6% (33/140). Logistic regression analysis demonstrated that LMWH significantly and independently lowered the risk of recurrent APO (adjusted OR=0.08, 95% CI 0.01-0.45), whereas history of fetal growth restriction (OR=3.88, 95% CI 1.51-9.99) and positive results for inherited thrombophilias (OR=6.96, 95% CI 1.58-30.67) increased the risk.

Conclusion: In patients with rigorously defined history of severe APO, prophylaxis with LMWH is associated with a significant reduction in recurrence of severe APO.