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Query: UMLS:C0002871 (anemia)
 52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiovascular responses have been studied in baboons, after total exchange transfusion with hemoglobin solutions having various P50 values. At the end of the exchange transfusion, the hematocrit was 1.5%, the mean hemoglobin concentration was 4.4 g/dl, and the P50 varied between 12 and 26 mm Hg. Cardiac output did not change during the study, although heart rate increased, and stroke volume and MAP decreased. Hemoglobin concentration, per se, does not appear to be the critical stimulus for an increase in cardiac output with hemoglobin solution. In addition, the position of the hemoglobin-oxygen dissociation curve does not appear to influence these hemodynamic responses. The physiological response to anemia in the presence of hemoglobin solution appears different from that observed in the absence of plasma O2 carriers.
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PMID:Cardiac output response to extreme hemodilution with hemoglobin solutions of various P50 values. 11 94

The effects of 2 types of contraception, hormonal formulations and IUDs, on hemoglobin levels (HL) of users are discussed, based on findings of both cross sectional and longitudinal studies. In the cross sectional study, HL was determined in: 1) 428 women who came for contraceptive advice (controls); 2) 275 women wearing either copper or Lippes Loop IUD; 3) 106 women taking a wide variety of currently available combination pills (OCs); and 4) 20 women using injectable depot medroxyprogesterone (DMPA) at 150 mg/3 months. In the longitudinal study, HL was determined initially and after 6-12 months of use of the following contraceptives: 1) control group (30 women) of nonusers; 2) copper IUD wearers (20 Women); 3) OC users (102 women); and 4) injection of norethisterone enanthate at 20 mg/month (30 women). All participants were of low socioeconomic status. In the 1st study, mean HL in the control group was 12.7 + or -1.67 g/dl. Nearly 30% had HL below 12 gm/dl, but none had levels below 3 gm/dl. Mean LHs and frequency distribution of HL in subjects who had used a coppper IUD up to 3 years, Lippes Loop up to 10 years, combined OCs up to 18 months, and injectable progestagen up to 12 months were essentially similar to those seen in the control group. Data from the longitudinal study confirmed these findings. None of the women including those with menstrual disturbances showed any fall in HL of over 1 gm/dl. In general, long term IUD use did not affect anemia.
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PMID:Haemoglobin levels in contraceptive users. 51 Dec 58

Depo-Provera injections appear to be a safe and effective alternative for women who cannot tolerate the estrogenic side effects associated with oral contraceptives or the pain and bleeding associated with IUDs. However, women considering the method should be fully aware of the possible risks: (a) inability to withdraw the drug promptly in the event of a serious reaction, (b) disruption of menstrual patterns, and (c) delayed return of fertility after discontinuing therapy. Some women may consider the required trip to the doctor every 3 months an additional disadvantage. For women in developing countries where anemia and nutritional problems are prevalent, Depo-Provera has additional advantages in relation to IUDs and OCs: it causes less bleeding than IUDs or OCs and, unlike oral contraceptives, it does not suppress vitamin levels (4-8). Since it requires a trip to the doctor every 3 months, it also provides a better opportunity for medical supervision and care. For postpartum women who which to breastfeed their babies, Depo-Provera has the additional advantage of causing no adverse effect on lactation (1, 2, 13, 14, 16, 18, 19, 25, 32, 36).
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PMID:Experience with medroxyprogesterone acetate (Depo-Provera) as an injectable contraceptive. 60 84

Results from animal experiments have suggested that treatment with recombinant human erythropoietin (rHuEPO) causes changes in renal hemodynamics which are detrimental to renal function. Therefore, the effects of correction of the anemia by rHuEPO on glomerular filtration rate (GFR; inulin clearance) and effective renal plasma flow (ERPF; PAH clearance) were studied in eight pre-dialysis patients. The studies were done before (Hct 0.24 +/- 0.05 liter/liter) and at 89 +/- 19 days after the start of rHuEPO therapy (Hct 0.39 +/- 0.03 liter/liter). To further evaluate the effects of ACE inhibition, 25 mg of captopril was given orally after baseline values had been obtained. Baseline GFR, renal blood flow (RBF) and filtration fraction (FF) did not change during rHuEPO therapy. At low hematocrit (Hct) captopril induced a significant increase in ERPF and RBF, and a decrease in MAP. After correction of the hematocrit the blood pressure lowering effect of captopril remained unchanged. However, captopril no longer induced changes in ERPF and RBF. We conclude that the increase in hematocrit had no adverse effects on GFR. The results suggest that changes in hematocrit may influence the effects of ACE inhibition on efferent vascular resistance. Therefore, the hematocrit should be taken into account when evaluating studies on the effects of ACE inhibition in the progression of chronic renal failure.
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PMID:Evidence for renal vasodilation in pre-dialysis patients during correction of anemia by erythropoietin. 155 11

The results of 8 to 12 weeks of treatment of the anemia of uremia with rHuEPO in patients with chronic renal failure and uremia are: a sustained increased hematocrit; increased RBC mass, and subsequent increased MAP; and increased TPRI. The observed trends of decreased LVEF, and echo Doppler evidence of a trend toward LV systolic and diastolic dysfunction, although not individually statistically significant, represent 3 separate evaluation techniques coupled with hypertension and TPRI increase during administration of rHuEPO to increase the hematocrit and packed red blood cell volume in patients with chronic renal failure and anemia. Increased TPRI and hypertension associated with correction of uremic anemia vasodilation and the increased blood viscosity have been noted in earlier investigations with transfusions. The hypertension and elevated TPRI demonstrated during rHuEPO therapy in patients with progressive chronic renal failure associated with increased hematocrit, and the trends toward systolic and diastolic cardiac dysfunction are noted herein. These changes were associated with the combined increase of packed RBC mass and plasma volume in this study. The natural progressive course of worsening of renal function exhibited by these patients could have limited their ability to regulate plasma volume, making them vulnerable to volume-dependent hypertension and a significant preload adding to potential cardiac dysfunction in addition to the increased TPRI.
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PMID:Cardiovascular hemodynamic effects of correction of anemia of chronic renal failure with recombinant-human erythropoietin. 205 68

We examined the cardiovascular and metabolic response to RBC transfusion in patients with circulatory shock after volume resuscitation. Data were analyzed from 36 transfusions in 32 patients who were undergoing continuous hemodynamic monitoring. Transfusions were administered for moderate to severe anemia, mean Hgb 8.3 g/dl. The diagnosis were sepsis (19/36), cardiogenic shock (14/36), connective tissue disease (2/36), and severe hypocalcemia (1/36). Benefit from transfusion was defined as an improvement in tissue oxygen utilization (increased oxygen consumption [VO2] or decreased lactate), a decrease in myocardial VO2 (MAP x HR), or a decrease in myocardial work (left ventricular work index). Mean transfusion volume was 577 ml over 4.5 h. Hgb and oxygen delivery (DO2) increased by 27% and 28%, respectively, while pulmonary artery wedge pressure and cardiac index were unchanged. No significant change was noted in VO2, or lactate, after augmentation of red cell mass. An increase occurred in myocardial work indices and MAP x HR. No changes were identified when subgroups were analyzed based on diagnosis, pretransfusion Hgb, lactate, or VO2 levels. We conclude that selective increase in DO2 by augmentation of RBC mass and oxygen-carrying capacity did not improve the shock state in these volume-resuscitated patients, regardless of the etiology of the shock.
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PMID:Cardiovascular and metabolic response to red blood cell transfusion in critically ill volume-resuscitated nonsurgical patients. 239 7

Slow progressive improvement of renal anemia from 21 up to 33% hematocrit by rhEPO treatment results in an increase of tissue oxygenation as indicated by a rise of the transcutaneous oxygen pressure. In normotensive patients this was accompanied by an increase in MAP (delta 6 mm Hg) within the normal range and a significant fall of the regional blood flow. These hemodynamic changes are caused by increases of the regional and presumably also of the total peripheral vascular resistance. Most likely the increase in total peripheral vascular resistance represents an autoregulatory event triggered by the rising tissue oxygenation. From the present data it is difficult to estimate to what extent the observed rise in hematocrit affects peripheral vascular resistance also via an increase of blood viscosity.
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PMID:Effect of treatment with recombinant human erythropoietin on peripheral hemodynamics and oxygenation. 329 47

Dysfunctional uterine bleeding (DUB), menstrual bleeding not explained by organic pathology in the pelvis or systemic deseases that exacerbate bleeding, is suspected when a reproductive-aged woman has excessive menstrual flow. Ovulatory DUB is most common in parous women aged 30-45 years. Cycles are regular and predictable and menstrual flows are preceded by breas soreness, mood or energy changes, or pelvic discomfort. Hypochronic microcytic anemia may result from the amount, rapidity, and duration of bleeding. Current evidence supports the hypothesis that DUB is associated with an increased total amount of prostaglandin in the uterus. Prostacyclin appears to be a likely cause of menorrhagia because it is locally produced within the intima of vessels and is a powerful vasodilator and effective inhibitor of platelet aggregation. DUB diagnosis requires careful exclusion of organic pathology through a detailed history, complete physical examination, and a complete blood count. A beta-human chorionic gonadotrophin measurement to rule out obstetric accident, curettage, hysteroscopy, biopsy, or laparoscopic visualization may be appropriate under different conditions. Curettage, thyroid hormone administration, ergot alkaloids, vitamin and mineral preparations, and iron therapy do little to correct the basic problem. Aspirin should be avoided in the week before and on the days of flow since in analgesic doses it inhibits the platelet thromboxanes that promote platelet agggregation and local vasoconstriction. Bed rest or reduced physical activity on days of flow is also advisable. Nonsteroidal antiinflammatory drugs are effective in reducing blood loss in women with DUB. The durgs are prostaglandin synthetase inhibitors, but the biochemical modifications causing an improved bleeding pattern are not well understood. All such drugs are effective, but some women experience greater relief with 1 formulation than another. Medroxyprogesterone acetate, 10 mg dialy for 7 days before the onset of flow, reduces bleeding in some women although the mechanism of action is unclear. Oral contraceptives (OCs) containing progestins derived from 19-nortestosterone inhibit endometrial proliferation, so ther is little tissue to be shed and little local prostaglandin to stimulate bleeding. Nonsmoking women under 40 years old with DUB who desire reversible contraception are excellent candidates for OCs. Aminocaproic acid is very expensive and has annoying gastrointestinal side effects. but is cost-effective for women with chronic anemia or life threatening uterine hemorrhage who wish to avoid hysterectomy. Danazol is of little usefulness because of its expense and side effects. Hysterectomy is an acceptable therapeutic option for many women.
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PMID:Dysfunctional uterine bleeding in ovulatory women. 388 Aug 90

In 74 chronic glomerulonephritis (CGN) and 13 hemodialysis patients (HD) blood volume and hemodynamic indices were examined. Significant correlation was observed between MPA and PV in CGN. High PV in high S-Cr group is considered to be correlated with anemia. Salt restriction reduced MAP without the change in BV in the impaired kidney function group in CGN. Volume depletion in HD shifted TPRI to lower level in the group with significant MAP reduction. The results indicate that sodium rather than water will play an important role in this type of hypertension.
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PMID:Hypertension in chronic glomerulonephritis. 675 Jan 90

Mortality is the greatest concern in assessing risks of modern reversible contraception. The problems identified with older oral contraceptives (OCs) have decreased with the lower doses in current OCs. These problems include cardiovascular and thrombotic effects, changes in lipid metabolism, breast cancer, liver cancer, increased risk of chlamydia cervicitis, no protection against sexually transmitted diseases (STDs) and HIV, and interferes with breast feeding. On the other hand, OCs protect against anemia, menstrual disorders, ectopic pregnancy, acute pelvic inflammatory disease (PID), and ovarian and endometrial cancer. Since the contraceptive implant, Norplant, has no estrogens, it does not have the cardiovascular risks associated with OCs. Possible risks from Norplant use include changes in carbohydrate, liver, and lipid metabolism but they tend to be clinically insignificant and no protection against STDs/HIV. Menstruation disorders are the major side effect. Apparent benefits of Norplant are protection against anemia and ectopic pregnancy and no effect on lactation. The injectable contraceptive, Depo-Provera, causes menstrual changes, may slightly increase the risk of breast cancer, may decrease bone density, and does not protect against STDs/HIV. It protects against endometrial cancer. It has no effect on metabolism. Risks associated with the IUD include PID, perforation, anemia, increased menstrual bleeding, and pregnancy. IUDs do not affect the quantity of composition of breast milk. They are best suited for women in a mutually monogamous, long-term relationship. Barrier methods provide some degree of protection against STDs/HIV and PID. Condoms provide the most protection. They do not affect lactation. Their major complications are contraceptive failure and risks associated with pregnancy. For all women, especially those in high risk categories, one must balance the risks of modern contraceptive use with the risks of childbearing and with their benefits.
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PMID:The safety of modern contraceptives. 784 6


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