OBJECTIVE:Anemia in patients presenting for elective surgery is associated with increased morbidity, allogeneic blood transfusion, and delay of surgery. Extract of sorghum bicolor has been shown to have hemopoietic, immune-stimulating, and antioxidant effects in rats and in patients with HIV. The aim of this study was to determine the effect of the extract in patients with preoperative anemia booked for myomectomy.

METHODS:Consenting patients (N = 66) were randomly assigned to two groups. The test group (n = 34) was given folic acid 5 mg/d, 200 mg iron tablet three times daily, and 500 mg/d of the extract. The control group (n = 32) was given the same doses of folic acid and iron for a period of 3 wk. Blood samples were taken atbaseline and weekly for full blood cell count and liver and kidney function tests. Participants were screened for tuberculosis, HIV, hepatitis, and sickle cell anemia.

RESULTS:Increases in red blood cell count, hematocrit, and hemoglobin concentration in participants in the test group were highly significant (P < 0.0002, P < 0.0001, and P < 0.0001, respectively). Participants in the control group had a significant increase in the hemoglobin concentration (P > 0.04). The changes in liver enzymes, urea, and creatinine for participants in the test group were within the normal ranges.

CONCLUSION:The addition of the extract of sorghum bicolor to routine hematinics is superior to the use of routine hematinics alone. Although the difference is not statistically significant, the extract will correct preoperative anemia in an additional 15% of the patients.

Celiac disease (CD) is Gluten sensitive enteropathy with a wide spectrum of severity and protean clinical manifestations. Patients with atypical (non-diarrhoeal) presentations are missed as the diagnosis of Celiac Disease is not considered. We present three young girls (ages 18, 19, 23 at presentation) who were admitted to our hospital as intractable seizures. All had low serum calcium, features of rickets/osteomalacia and anaemia. This prompted us to consider malabsorption due to CD. The diagnosis of CD was confirmed by serologic tests (IgA transglutaminase and IgG antigliadin antibodies) and biopsy of the duodenum. In all patients gluten free diet not only provided drug free control of seizures but also helped correct other features of malabsorption like hypocalcaemia and anaemia as the primary pathology behind these symptoms was corrected. We wish to highlight that hypocalcaemia of CD which may present as intractable seizures can be treated only by treating CD with gluten free diet and not by oral vitamin D and Calcium alone.

Introduction The achievement of erythropoiesis in hemodialysis (HD) patients is typically managed with erythropoiesis-stimulating-agents (ESA's) and intravenous iron (IV-iron). Using this treatment strategy, HD patients frequently show an elevated fraction of red blood cells (RBC) with hemoglobin (Hb) content per cell that is below the normal range, called hypochromic RBC. The low Hb content per RBC is the result of the clinical challenge of providing sufficient iron content to the bone marrow during erythropoiesis. Vitamin C supplements have been used to increase Hb levels in HD patients with refractory anemia, which supports the hypothesis that vitamin C mobilizes iron needed for Hb synthesis. Methods We conducted a cross-sectional survey in 149 prevalent HD patients of the percent hypochromic RBC, defined as RBC with Hb < 300 ng/uL of packed RBC, in relation to plasma vitamin C levels. We also measured high-sensitivity CRP, (hs-CRP), iron, and ferritin levels. and calculated ESA dose. Findings High plasma levels of vitamin C were negatively associated with hypochromic RBC (P < 0.003), and high ESA doses were positively associated (P < 0.001). There was no significant association of hs-CRP with percent hypochromic RBC. Discussion This finding supports the hypothesis that vitamin C mobilizes iron stores, improves iron delivery to the bone marrow, and increase the fraction of RBC with normal Hb content. Further research is warranted on development of protocols for safe and effective use of supplemental vitamin C for management of renal anemia.

ETHNOPHARMACOLOGICAL RELEVANCE:Sports anemia is a persistent and severe problem in athletes owing to strenuous exercise-induced oxidative stress and hepcidin upregulation. The roots of Angelica sinensis (AS), a familiar traditional Chinese medicine, has been used for replenishing blood since antiquity.

AIM OF THE STUDY:To evaluate the effects of ethanolic AS extract in a 4-week study on sports anemia in female Wistar rats.

MATERIALS AND METHODS:To induce anemia, a strenuous exercise protocol consisting of running and swimming was employed with increasing intensity. Animals were randomly assigned to the following groups: control group; strenuous exercise group; and strenuous exercise and AS extract-treated group (300mgkg(-1)d(-1)). After 4 weeks, rats underwent exhaustive swimming and forelimb grip strength test. The blood biochemical markers and hepatic antioxidant activities were determined. Hepatic interleukin-6 and muscle glycogen were observed through immunohistochemical and Periodic acid-Schiff staining, respectively.

RESULTS:AS extract (consisting of ferulic acid, Z-ligustilide, and n-butylidenephthalide) treatment improved forelimb grip strength and rescued exercise-induced anemia by significantly elevating the red blood cell counts and hemoglobin concentrations as well as hematocrit levels (p<0.05). AS modulated the iron metabolism through decreasing serum hepcidin-25 concentrations by 33.0% (p<0.05) and increasing serum iron levels by 34.3% (p<0.01). The hepatic injury marker serum alanine aminotransferase concentrations were also reduced, followed by increased antioxidant enzyme catalase expression in the liver (p<0.05). Furthermore, substantial attenuation of hepatic interleukin-6 expression and preservation of muscle glycogen content suggested the additional roles of AS acting on sports anemia and physical performance.

CONCLUSION:Our findings evidenced a novel and promising therapeutic approach for AS treatment for rescuing the anemic condition induced following 4 weeks of strenuous exercise.

OBJECTIVE:To assess anaemia and oxidative stress in rats that were injected lead and to evaluate the possible effects of ascorbic acid supplementation on these parameters.

METHODS:This randomised control trial study was conducted at the Army Medical College, Rawalpindi, Pakistan, from October 2007 to September 2008, and comprised Sprague Dawley rats. The rats were randomly divided into three groups. The rats in Group 1 were given weekly injections of sodium acetate, and rats of Group 2 and 3 were given weekly injections of lead acetate. Ascorbic acid was supplemented in the drinking water of rats of Group 3. At the end of six weeks, terminal sampling was done and blood obtained was used to assess the serum malondialdehyde levels and red cell parameters.

RESULTS:Of the 105 rats, each group had 35(33.33%). The overall mean age was 105±15 days and the mean weight was 225±25gm. The mean malondialdehyde level was 3.2±0.39 µmol /L in Group 1, 7.8±0.48 in Group 2 and 3.8±0.34 in Group 3 (p<0.001). The mean haemoglobin level was 13.16±0.57 g/dL, 10.64±0.86 and 12.22±0.81, respectively (p<0.001). The red blood cells count was 7.63±0.33 106/µL in Group 1, 6.29±0.54 in Group 2 and 6.83±0.45 in Group 3 (p<0.001).

CONCLUSIONS:Administration of ascorbic acid in drinking water significantly reduced the oxidative stress and anaemia caused by lead intoxication.