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

Various factors are involved in the pathogenesis of anemia in dialysis patients. Reduced erythropoiesis is mainly attributed to erythropoietin deficiency. Stimulation of erythropoiesis may be promoted by androgens. Substitution of iron is recommended in case of iron deficiency. As a rule, supplementation of vitamin B12 is not necessary, but administration of folic acid is recommended. Treatment of anemia in renal failure is rendered more effective by increased technical efficiency in hemodialysis permitting a relatively protein-rich diet. Blood transfusions are not necessary during routine treatment of dialysis. Since bilateral nephrectomy will always provoke severe anemia, it should be reserved to special cases of severe hypertension. Until now, no conservative therapy has been developed which would allow optimal treatment of anemia in dialysis patients. Successful renal transplantation still is, and will be, the best therapeutic intervention.
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PMID:[Anemia in terminal kidney failure. Pathogenesis and therapy]. 83 56

Crohn's disease is manifested by fissure ulcers, transmural inflammation with lymphocytes, and granulomata affecting any part of the gastrointestinal tract. There seems to be a genetic predisposition, conditioned perhaps by environmental factors and possibly a virus. The disease is characterized by spontaneous fistulae, internal and external, anal lesions, stricture formation, and healing by fibrosis. The presenting symptoms are intestinal and systemic (Table 2). Systemic manifestations, such as arthritis, skin lesions, episcleritis and uveitis, pericholangitis, hydronephrosis, renal stones, amyloidosis, arrested maturation, fever, and anemia occur as complications of the intestinal disease. Medical treatment is empirical and supportive. Surgical treatment is reserved for complications. The incidence of Crohn's disease seems to be increasing because our diagnostic techniques are improving, but our treatment is unsatisfactory.
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PMID:Crohn's disease. 104 36

Transfer of fetal red blood cells and platelets to the maternal circulation can stimulate an immune response with production of immunoglobulin that can cross the placenta. Similarly, passage of maternal stem cells to an immunologically incompetent fetus can theoretically produce graft-versus-host disease. disease. Maternal sensitization to red blood cell antigens such as D and Kell can result in anaemia, hydrops, and death in an incompatible fetus. Current assessment of these pregnancies involves serial analysis of amniotic fluid bilirubin concentration, with umbilical cord blood sampling reserved for special circumstances; neither ultrasound or Doppler blood flow analysis are accurate in the prediction of fetal haematocrit. Intravascular transfusion is the treatment of choice for hydropic fetuses. Perinatal survival in non-hydropic fetuses is similar with either intravascular or intraperitoneal transfusion, and the choice of procedures is individualized. Isoimmune fetal thrombocytopenia is usually the result of maternal sensitization to the PlA1 antigen. There is significant risk of intracranial haemorrhage, both antepartum and during labour and delivery. Umbilical cord blood sampling at term can determine fetal platelet count and the need for platelet transfusion, and can aid in deciding the appropriate route of delivery.
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PMID:Alloimmune conditions and pregnancy. 144 20

Congenital and acquired diverticula of the jejunum and ileum in the adult are unusual and occur in approximately 1 percent to 2 percent of the population. They are pulsion diverticula thought to be the result of intestinal dyskinesia. These lesions can produce a significant diagnostic and therapeutic dilemma. They are multiple in the jejunum and solitary distally and are characteristically found in 60- or 70-year-old males. The diagnosis may be confirmed with contrast studies of the small intestine, arteriography, or nuclear scan. Consider these disorders in patients with 1) unexplained gastrointestinal bleeding, 2) unexplained intestinal obstruction, 3) an unexpected cause of acute abdomen, 4) chronic abdominal pain, 5) anemia, or 6) malabsorption. Medical therapy is helpful in controlling diarrhea and anemia, while surgical therapy is reserved for hemorrhage, obstruction, perforation, or failure of medical management. Asymptomatic diverticula discovered on routine contrast studies need not be resected. At surgery, incidental diverticula should be removed when evidence of dilated, hypertrophied loops of small bowel with large diverticula is found. Intraoperative air distention will aid in diagnosis. Resection and primary anastomosis is the preferred treatment for non-Meckelian diverticula. Diverticulectomy is reserved for a Meckel's diverticulum without evidence of ulceration. An incidental Meckel's diverticulum should be removed in the presence of mesodiverticular bands or ectopic tissue. Removal of a Meckel's diverticulum is not advised in the patient with Crohn's disease but may be performed in the patient undergoing restorative proctocolectomy for ulcerative colitis.
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PMID:Clinical implications of jejunoileal diverticular disease. 158 62

The goal of fluid therapy in the PACU setting is the restoration of blood volume and tissue perfusion. Choosing the type of fluid infusion depends on the preoperative, intraoperative, and postoperative condition of the patient. An understanding of the functional fluid compartments, the composition of body fluids and commercially available fluids, and the steps to evaluate fluid depletion allow one to determine the fluid needs of the patient. The orderly and expedient evaluation of fluid status of the postoperative patient involves the assessment of volume status, concentration status, composition status, and signs and symptoms of inadequate tissue perfusion. Recovery after surgery is a dynamic process, and fluid reassessment should be conducted periodically. Fluid challenges may be necessary in the hypovolemic patient or in patients with clear signs and symptoms of end-organ hypoperfusion. Weil and Rackow and Shoemaker provide useful approaches to fluid challenge guided by CVP and PAP monitoring. The decision of whether to use crystalloids or colloids for fluid resuscitation is complex, controversial, often determined by personal preference and concern over expense, and may be inconsequential as long as fluids are infused appropriate to the needs of the patient. There are disadvantages and advantages to both crystalloid and colloid fluid administration. As with any therapeutic intervention, there are complications with fluid administration, congestive heart failure and pulmonary edema being of more immediate concern. Finally, blood components are colloid-type solutions that should be reserved for specific patient problems. Red blood cells are indicated to increase oxygen-carrying capacity in patients with anemia. Platelets are used to treat bleeding associated with deficiencies in platelet number or function. Fresh frozen plasma is transfused to increase clotting factor levels in patients with demonstrated deficiency. A good understanding of fluid types available, of a systematic approach to evaluating fluid depletion, and of the indications for blood component therapy will allow one to make appropriate decisions when implementing fluid therapy in the PACU.
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PMID:Fluid therapy in the PACU. 204 19

A five year experience with spontaneous perirenal hemorrhage at the Brigham and Women's Hospital was reviewed, with 15 instances identified. Ages ranged from 17 to 80 years (mean of 56 years). Abdominal or flank pain was the presenting symptom in 13 patients; one patient was in a state of shock. Anemia and elevation of lactate dehydrogenase were uniformly present during acute evaluation. Computerized tomography (CT) identified lesions other than hematoma in ten of 14 instances. Arteriography was essential to the diagnosis of two vascular lesions not appreciated by other imaging modalities. Intravenous pyelography and ultrasound did not add significantly to findings on CT or arteriography. Six patients underwent serial CT evaluation; three with persistent nonfatty lesions had carcinoma of the kidney confirmed at operation. Carcinoma of the kidney occurred in a total of eight patients and angiomyolipoma in three patients. It was suggested that patients with clinical evidence for spontaneous perirenal hemorrhage should be evaluated by CT, with arteriography added when the underlying cause remains uncertain. Nephrectomy should be performed for CT evidence of nonfatty lesions other than hematoma. Other patients may have serial CT with nephrectomy reserved for persistent abnormalities. The protocol decreases the likelihood of nephrectomy for benign disease while addressing the high incidence of carcinoma of the kidney among patients with spontaneous perirenal hemorrhage.
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PMID:Rational approach to evaluation and management of spontaneous perirenal hemorrhage. 230 Aug 64

Iron deficiency frequently complicates both acute and chronic phases of recombinant human erythropoietin (r-HuEPO; EPOGEN [epoetin alfa], AMGEN Inc, Thousand Oaks, CA) therapy for dialysis-associated anemia. During acute correction of anemia, iron needed for new hemoglobin production may outstrip available body iron stores. During maintenance r-HuEPO therapy, blood lost both through the dialysis process and the uremic predisposition to gastrointestinal bleeding promotes ongoing negative iron balance. Failure to recognize and treat iron deficiency may lead to impaired efficacy of r-HuEPO in the anemic patient by converting the anemia associated with chronic renal failure to the anemia associated with iron deficiency. The risk of iron deficiency is assessed by weighing available iron stores, as reflected by the level of serum ferritin, against anticipated iron needs for new hemoglobin synthesis, as measured by the difference between the current and target hemoglobin. Using this approach, body iron reserves can be determined, iron deficits predicted, and appropriate iron replacement therapy planned. Once patients are identified as being at risk for iron deficiency, they are treated prophylactically with oral iron supplements. Parenteral iron therapy is reserved for those at greatest risk for iron deficiency during acute r-HuEPO treatment and those intolerant or unresponsive to oral iron supplements during chronic r-HuEPO treatment. Although no dose-response relationship has been observed in the restoration of iron balance with oral iron supplements, those taking supplements show distinctly higher projected iron stores and daily iron balance than those not given supplements.
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PMID:Iron deficiency in patients with dialysis-associated anemia during erythropoietin replacement therapy: strategies for assessment and management. 266 82

Despite a severely inadequate supply of blood in African countries, the misuse or overuse of blood exists in many countries, particularly Nigeria, and compromises the efficiency of blood transfusion services. The aim of this retrospective study was to find out the problems of blood usage and to make recommendations for the improvement of blood transfusion services in the Obstetrics/Gynecology Department of the University of Benin Teaching Hospital. The department is the largest user of blood in this hospital. The records of 500 consecutive patients who received 1,264 units of blood in the department over a 3-year period (1979-1982) were analysed. 1 major problem identified was "single unit transfusion" in 23.2% of the patients, (needless transfusion of only 1 unit of blood). The next problem, in 15.2% of non-bleeding patients with chronic anemia, was the excessive reliance on the level of packed cell volume rather than on the clinical indications to justify the need for blood transfusion. The 3rd problem was the preponderance of emergency requests for blood, 53.8% of all cases, as compared to 48.2% of all cases, thereby depriving other departments in the hospital of blood reserved for elective procedures. The impact of these problems on the blood bank and on blood transfusion services in general are discussed, and the propoer indications for blood transfusion reviewed.
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PMID:Blood transfusion in obstetrics and gynaecology: pattern, problems and prospects. 370 92

This report describes the current status of maternal and child health care (MCH) in Mozambique and was prepared by an American nurse-midwife, hired by the Mozambique government as an instructor for the country's nurse-midwife training program. The socialistic government, under its international cooperates program, hires advisors and instructors to help implement the nation's many health, education, and economic development programs. In 1975, when the country was granted independence, the health care system was grossly inadequate. During the colonial period, the health system was oriented toward providing care for the white, urban population rather than for the country's largely rural population. Prefessional jobs were reserved for Portuguese nationals, and Africans were not allowed to attend the nationhs medical schools. When independence was obtained, all but 50 of the nation's 600 physicians left the country. The development of MCH services is given a high priority by the current government. It is estimated that currently 35% of the all children born in the country die before they reach the age of 5 years. The maternal mortality rate is estimated to be 300/100,000. Efforts to improve health conditions are hindered by a lack of trained personnel, money, and medical equipment and supplies and by an inadequate transportation network. Despite these obstacles, progress in the provision of MCH services is being made. MCH units are being established throughout the country. These units are generally operated by trained nurse-midwives. A national nurse-midwife training program is conducted at the National Health Science Institutes in Quelimane. Trainees must be at least 18 years of age and have 6 or more years or primary schooling. The 2 1/2-year training program is intensive and students receive practical experience by working at an adjacent provincial hospital. Upon graduation, most assume the responsibility for operating a rural MCH unit. They are expected to provide services for a large population and to do so with little or no medical backup and minimal equipment and supplies. As part of their training, they learn how to prioritize health care and how to recruit community volunteers to help run the unit. The rural MCH units provide prenatal services, including high risk pregnancy referrals, nutritional counseling, and treatment for parasites and anemia. Many of the nurse-midwives operate well child clinics. These clinics provide immunization and chloroquinization services and treatments for parasites and anemia for children under the age of 5 years. Nutritional counseling is provided for the mothers of the children. Growth charts are used to identify malnourished children in need of hospital care. The midwives encourage breastfeeding. Recently a family planning component was added to the MCH program. Oral contraceptive, IUDs, foam, and condoms are provided. The program stresses the use of contraception for spacing rather than for limiting child births. Infertility is common among the rural women, and some midwives provide limited infertility counseling and evaluation. 30% of the country's deliveries are now performed in maternity units. These units range from hospital facilities to small, minimally equipped rural units. In most rural units, the deliveries are performed by nurse-midwives without medical assistance. Given the poor health status of rural women, pregnancy complications are common, and the units are too inadequately equipped and staffed to cope effectively with these complications. As a result, maternal morbidity and mortality is high. The majority of the country's deliveries are still performed at home by untrained traditional birth attendants. No effort is being made to train the traditional birth attendants or to bring them into the national health care system.
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PMID:Nurse-midwifery in a developing country: maternal and child health in Mozambique. 656 73

Oral contrceptives (OCs), usd by over 30% of reproductive aged women in Belgium, are by far the most widely used contraceptive in that country. The various types of OCs include monophasic, biphasic, and triphasic combinations of an estrogen and a progestin, sequentials containing estrogen only for 7-14 days followed by a progestin through the 21st day; macrodose or microdose progestin only formulations, 3-month injectable progestins, and the morning after pill. Side effects of OCs are mainly due to metabolic effects on coagulation factors, the renin-angiotensin system, glucose tolerance, or the lipid profile. Users of OCs face increased risks of cholelithiases, thrombophlebitis, thromboembolism, cerebrovascular accidents, myocardial infarcts (among smokers over 35 years of age), and hepatic adenomas. The most troubling secondary effect is the excess cardiovascular morbidity and mortality show by contraceptive users, not just those who are obese, hypertensive, or who have histories of vascular pathology, but also those over 40 years of age and smokers. Lenght of use of OCs does not increase vascular risks. Epidemiologic studies demonstrate that vascular risks are reduced in lower dose formulations. Absolute contraindications to OC use include serious cardiovascular problems, severe hepatic pathology, estrogen-dependent tumors, pregnancy and undiagnosed gynecologic problems, and significant hyperlipidemia. Relative contraindications include severe headaches, cholelithiase, previous cholestasis of pregnancy, severe renal disease, fibromyomas, benign breast disease, age over 40 years, smoking, surgery anticipated within 4 weeks, infectious mononucleosis, falciform anemia, and immediate postpartum and lactation. Epilepsy, diabetes, depression, and varicose veins are not strictly speaking contraindications but require additonal surveillance. Lower dose formulations should be prescribed if possible. OC users should be followed up every 6-12 months. Among other steroidal contraceptive methods, sequential OCs and high dose progestin-only formulations are used for short-term treatment of specific conditions. Progestin-only minipills are used when an OC is desired but estrogens are contraindicated. Injectable progestins should be reserved for patients who for cultural or medical reasons can use no other type of contraceptive. Morning-after pills should not be considered a regular form of contraception. If OCs are used in adolescents, a low dose pill is indicated. Low dose OCs may be indicated for diabetics because of the danger of infection with IUDs and the lesser efficacy of barrier methods. If OCs are used in epileptics, they should be regular dosed because of the danger of drug interactions. Only low-dose formulations and progestin-only minipills should be used by women over 40.
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PMID:[The choice of oral contraception in 1984: general indications and specific cases]. 672 93


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