Adapting to the IFCC system of reporting HbA1c poses a challenge to generations of health professionals who have learnt the percentage system related to the major clinical trials, in type 1 and type ...2 diabetes, the DCCT and UKPDS. This handy paperback illuminates the transition path. Using real-life case studies to illustrate actual clinical situations, the book shows you how to use mmol/mol units in daily practice. Each case study shows the old percentage units alongside the IFCC units for quick comparison. Produced in association with Diabetes UK, this pocketbook helps you work with confidence in the IFCC system.
The original article 1 contained an error whereby Table 5 within the Appendix is presented incorrectly. This error has now been corrected and Table 5 is presented appropriately.
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Giriş: Akut pulmoner emboli (PE) acil kliniklerinde sık karşılaşılan ve mortalitesi yüksek bir klinik tablodur (1). PE'nin kaynaǧı büyük oranda alt ekstremite derin venlerinde gelişen trombüslerdir ...(DVT) (2). Son zamanlarda, ucuz ve pratik laboratuvar testleri olarak tam kan hücresi sayımı parametrelerinden olan hemoglobinin (Hb) eritrosit daǧılım genişliǧine (RDW) oranı, kardiyovasküler hastalıkların tarama, tahmin, sınıflandırma, prognoz ve tedavi izleme ile ilgili potansiyel faydaları nedeniyle ilginç bir araştırma alanı haline gelmiştir(3-6).AmaçBu çalışmadaki amaç akut PE'li hastalarda DVT varlıǧı ile Hb/RDW oranı arasında ilişki olup olmadıǧının araştırılmasıdır. Metod: Çalışmamız retrospektiftir. Hastane kayıt sisteminden Ocak 2022-Haziran 2022 arasında akut PE saptanan ardışık 115 hasta çalışmaya dahil edildi. Dışlanma kriterlerine uymayan 15 hasta çalışma dışı bırakıldı. Çalışmanın dışlanma kriterleri; aktif enfeksiyon varlıǧı, gebelik, orta ve ciddi seviyede karaciǧer ve renal yetersizlik, 18 yaşından küçük olmak olarak belirlendi. Hastane kayıt sisteminden hastaların demografik, klinik, laboratuar ve transtorasik ekokardiyografi (TTE) verilerine ulaşıldı. Bu veriler ışıǧında PE ciddiyet endeksi (PESİ) skoru hesaplandı. Hastalar DVT varlıǧına göre gruplandırıldı. DVT saptananlar Grup 1; saptanmayanlar Grup 2 olarak belirlendi. Bulgular: Grup 1' de 46 hasta varken; grup 2' de 54 hasta mevcuttu. Grup 1'in medyan yaşı 56 iken; grup 2' nin medyan yaşı 53'tü. Grup 1 27 (%58.7) erkek hastadan; Grup 2 ise 25 (%46.3) erkek hastadan oluşuyordu. Gruplar yaş ve cinsiyet açısından benzerdi (p > 0.05) (Tablo 1).Hastalar kronik hastalıkları, sigara öyküsü, yolculuk, operasyon varlıǧı, TTE bulguları açısından karşılaştırıldı. Sonuçlar Tablo 1' de özetlendi. Hastaların açlık kan glukozu, kreatinin, D-Dimer, hemoglobin, RDW ve Hb/RDW deǧerleri karşılaştırıldıǧında Hb/RDW Grup 2'de Grup 1' e göre daha yüksek saptandı (p = 0.033). Diǧer deǧişkenler açısından gruplar benzerdir (p > 0.05)(Tablo 1).Grup 1' de Hb/RDW ile PESİ skoru, kreatinin, yaş, D-Dimer, açlık kan glukozu, EF arasında korelasyon varlıǧı açısından deǧerlendirildi. Hb/RDW ile PESİ skoru arasında negatif yönlü ve EF arasında ise pozitif yönlü korelasyon saptandı(Tablo 2). Tartışma: Ucuz ve kolayca ölçülebilen bir laboratuvar deǧişkeni olan Hb/RDW oranı akut pulmoner emboli hastalarında, DVT' nin varlıǧı ile baǧımsız ve önemli ölçüde ilişkiliydi. Ayrıca azalmış Hb/RDW'nin yalnızca venöz trombozla ilişkili olmadıǧını, aynı zamanda acil servise gelen akut PE hastalarında venöz tromboz şüphesini destekleyerek temel risk deǧerlendirmesinin etkinliǧini artırabileceǧini düşündürmektedir. Bununla birlikte, ilişkilendirme mekanizması daha fazla çalışma gerektirir.
To investigate the predictability of genetic adaptation, we examined the molecular basis of convergence in hemoglobin function in comparisons involving 56 avian taxa that have contrasting altitudinal ...range limits. Convergent increases in hemoglobin-oxygen affinity were pervasive among high-altitude taxa, but few such changes were attributable to parallel amino acid substitutions at key residues. Thus, predictable changes in biochemical phenotype do not have a predictable molecular basis. Experiments involving resurrected ancestral proteins revealed that historical substitutions have context-dependent effects, indicating that possible adaptive solutions are contingent on prior history. Mutations that produce an adaptive change in one species may represent precluded possibilities in other species because of differences in genetic background.
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Introduction:
Blood transfusions continue to be a critical intervention in patients presenting to emergency departments (ED). Improved understanding of the adverse events associated with transfusions ...has led to new research to inform and delineate transfusion guidelines. The Nova Scotia Guideline for Blood Component Utilization in Adults and Pediatrics was implemented in June 2017 to reflect current best practice in transfusion medicine. The guideline includes a lowering of the hemoglobin threshold from 80 g/L to 70 g/L for transfusion initiation, to be used in conjunction with the patient's hemodynamic assessment before and after transfusions. Our study aims to augment understanding of transfusion guideline adherence and ED physician transfusing practices at the Halifax Infirmary Emergency Department in Nova Scotia.
Methods:
A retrospective chart review was conducted on one third of all ED visits involving red-cell transfusions for one year prior to and one year following the guideline implementation. A total of 350 charts were reviewed. The primary data abstracted for the initial transfusion, and subsequent transfusion if applicable, from each reviewed chart included clinical and laboratory data reflective of the transfusion guideline. Based on these data, the transfusion event was classified one of three ways: indicated based on hemoglobin level, indicated based on patient's symptomatic presentation, or unable to determine if transfusion indicated based on charting.
Results:
The year before guideline implementation, the total number of transfusions initiated at a hemoglobin of between 71-80 was 31 of 146 total transfusions. This number dropped by 23.6% to 22 of 136 in the year following guideline implementation. The number of single-unit transfusions increased by 28.0% from 47 of 146 in the year prior to 56 of 136 in the year after guideline implementation. The initial indication for transfusion being unable to be determined based on charting provided increased by 120%. The indication for subsequent transfusions being unable to be determined based on charting increased by 1500% (P < 0.05).
Conclusion:
These data suggest that implementing transfusion guidelines effectively reduced the number of transfusions given in the ED setting and increased the number of single-unit transfusions administered. However, the data also suggest the need for better education around transfusion indications and proper documentation clearly outlining the rationale behind the decision to transfuse.
Hemoglobin (Hb) heterogeneity arises mainly from posttranslational modifications of the globin chains, and cation-exchange chromatography reveals falsely increased concentrations of some minor Hbs in ...the presence of abnormal Hbs. Here we describe a method for identification of the globin chains and their posttranslational modifications contained in the Hb fractions.
We used cation-exchange HPLC (PolyCAT A column) for separation of Hb fractions and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) for analysis of the separated globin chains. Globin chains were identified by their molecular masses. Posttranslational modifications of globin chains were identified by digestion of the proteins with endoproteinase V8 before MALDI-TOF MS of the resulting peptides.
Analysis of the HbA2 fractions of patients with HbS revealed 4 different globin chains. We found, in addition to the expected alpha- and delta-chains, the carbamylated alpha- and the betaS-chains. Additionally, we analyzed HbH, Hb Barts, HbA 1b, pre-HbA 1c, HbA 1c, HbF1, HbF, HbA 1d3a, HbA 1d3b, HbA2, and HbC1 fractions from control and pathologic blood samples. We identified several posttranslational modifications of the globin chains, such as pyruvatization, glycation, acetylation, carbamylation, and acetaldehyde adduct formation.
The native and posttranslationally modified globin chains in minor and major Hbs are unambiguously identified by MALDI-TOF MS. A minor Hb containing the carbamylated alpha- and the betaS-chain elutes at the same time as normal HbA2 (alpha2delta2) and thus leads to falsely increased HbA2 values in patients with HbS when blood is analyzed with PolyCAT A chromatography.
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