Background: Early detection of iron-deficiency anemia (IDA) can enhance the efficiency and effectiveness of clinical treatment and quality of life for end-stage renal disease (ESRD) patients. This study aimed to evaluate the validity of CHr and %Hypo in screening IDA among ESRD patients and compare their performance with screening IDA among non-ESRD patients. Method: A retrospective analysis of 312 participants was conducted at Cho Ray Hospital, Vietnam, including healthy control participants and ESRD patients. Receiver operator characteristics curves and the area under the curve (AUC) of models were used to evaluate the performance of CHr, %Hypo. Optimal cutoff values were determined using Youden's index. Results: Detecting IDA in ESRD patients is more complicated, as the screening performance of CHr and %Hypo in predicting IDA among ESRD patients were lower than non ESRD group, but still reasonable with AUC = 0.748 (95% CI: 0.656-0.840, power = 0.997) and 0.740 (95% CI: 0.647-0.833, power = 0.996), respectively. Cutoff values of CHr < 31.5 pg and %Hypo> 10.0 pg are recommended to obtain optimal screening ability for Vietnamese ESRD patients. Conclusion: CHr and %Hypo appears to be useful tools for screening IDA among both non ESRD and ESRD patients. The low cost and accessible of the two markers encourage their utility as effective screening tools in clinical practice.

Rationale: Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening condition of antiphospholipid syndrome (APS). Treatment and management of CAPS remain challenging and the mortality rate is approximately 50% among cases. We describe a successfully treated case of a CAPS patient who had undergone massive bowel resection due to obstruction of superior mesenteric artery. Patient concerns: A 40-year-old male patient was admitted to our hospital with acute abdominal pain, melena, and a history of deep vein thrombosis in both legs for over 10 years, there was no previous diagnosis of APS. Diagnosis: The patient was diagnosed as CAPS with bowel necrosis due to obstruction of superior mesenteric artery based on the presence of antiphospholipid antibodies, computed tomography scan, and histopathological examination. Interventions: Emergency surgery was performed to remove approximately 6 meters of the necrotic small intestine, of which the length of the remaining small intestine was 40 cm from the duodenum and 80 cm from the ileocaecal valve. Anticoagulants were prescribed with low molecular weight heparin. After discharging, APS was managed with direct oral anticoagulants (DOACs) for secondary thromboprophylaxis because the patient was unable to reach target International Normalized Ratio (INR) with vitamin K antagonists (VKAs). Outcomes: During 24 months of follow-up until now, the patient did not develop new thrombosis or relapse CAPS and his state remained stable. Lessons: While VKAs is amongst the most important and fundamental treatment, physicians should be aware that VKAs are absorbed via the small intestine. For CAPS cases who had undergone massive bowel resection, DOACs is a reasonable alternative which has been found to be as safe and effective as VKAs in terms of thrombosis prevention.

Background Due to the increasing demand for kidney transplants, sometimes donors with underlying medical conditions can be considered for living kidney donor transplant. Thalassemia is amongst the most common inherited disorders of hemoglobin globally, which is not restricted as an exclusion criterion. However, there is currently no study examine the safety and characteristics of kidney donors with thalassemia minor. Methods All eligible live kidney donors between 2016 and 2019 with thalassemia minor at a tertiary hospital were recruited. Baseline characteristics, clinical and laboratory outcomes were investigated. Results Fifteen donors (11 women, 55.5 ± 15.0 year-old) were included with a follow-up duration of 2 (1-4) years since operation. The most prevalent gene mutation among participants was DEL-SEA. No clinical manifestations of anemia were seen but 10 participants had mild anemia diagnosed from blood tests. Cardiovascular, liver and renal function were normal before nephrectomy. Until now, all donors are alive and maintain overall good health. Anemia condition is not affected, and the post-donation eGFR = 71.04 ± 11.54 mL/min/1.73m2 is comparable to outcomes of healthy donors reported in previous studies. Two donors are at risk of proteinuria at 1-year post-transplant with A/C ratio > 30 mg/g. Conclusions Thalassemia minor individuals who are non-transfusion-dependent, without anemia clinical manifestations and have no contraindications to kidney donation are safe to be donors in short-term. An eGFR of at least 80 mL/min/1.73m2 should be considered to avoid low post-donation eGFR, and awareness should be raised on thalassemia donors with even mild albuminuria. Nephrectomy does not worsen thalassemia.

Mục tiêu: Mô tả đặc điểm lâm sàng, sinh học, điều trị ban đầu ở hai nhóm bệnh nhân giảm tiểu cầu miễn dịch người lớn có xét nghiệm kháng thể kháng nhân (ANA) dương và âm tính. Đối tượng: Bệnh nhân (BN) > 15 tuổi giảm tiểu cầu miễn dịch mới chẩn đoán được nhập viện vào khoa Huyết học bệnh viện Chợ Rẫy trong khoảng thời gian 02/2020 đến 07/2021, được làm xét nghiệm ANA trong quá trình tiếp cận chẩn đoán. Thiết kế nghiên cứu: Nghiên cứu mô tả hàng loạt ca, hồi cứu và tiến cứu. Kết quả: 149 bệnh nhân thỏa tiêu chuẩn chọn mẫu được đưa vào nghiên cứu. Tỉ lệ nam/nữ là 1/2,46. Tuổi trung bình là 46,56 tuổi. Tỉ lệ xuất huyết lúc nhập viện là 94%, thường nhất là độ II chiếm 60,4%, xuất huyết nặng độ IV chiếm 10,7%. Phần lớn BN nhập viện có xuất huyết da với 88,7%, kế tiếp là xuất huyết niêm mạc 48,9%. Trong nghiên cứu cũng ghi nhận 7/149 (5%) BN xuất huyết não được xác nhận bằng CT scan sọ não. 49% BN nhập viện với tình trạng thiếu máu. 40/149 (26,8%) BN có xét nghiệm ANA dương tính. 2/143 (1,4%) BN dương tính với anti DsDNA, đồng thời cũng dương tính với ANA. Số BN giảm C3 và C4 lần lượt là 10/125 (8%) và 13/125 (10,4). Không ghi nhận khác biệt về giới tính, độ tuổi, bệnh nền, vị trí xuất huyết, số lượng tiểu cầu, số ngày nằm viện và số đơn vị chế phẩm máu cần truyền. Yếu tố liên quan với giảm tiểu cầu miễn dịch (ITP) có hiện diện ANA được xác định là mức độ xuất huyết, thiếu máu và nồng độ Hemoglobin. Kết luận: Tỉ lệ dương tính của xét nghiệm ANA trong ITP mới chẩn đoán là 26,8% (95%CI:19,9-34,7%), nhiều nhất trong các xét nghiệm tầm soát bệnh tự miễn trong nghiên cứu (ANA, anti DsDNA, C3, C4). Những BN có hiện diện ANA có tỉ lệ xuất huyết nặng nhiều hơn, thiếu máu lúc nhập viện nhiều hơn và nồng độ Hemoglobin thấp hơn.

Post-transplantation anemia is common among renal transplant recipients (RTR). The most frequent causes are erythropoietin deficiency, acute allograft rejection, iron deficiency, hemolytic anemia, adverse effects of immunosuppressive therapy, and virus infection. Human parvovirus B19 (HPV B19) can cause persistent viremia and erythropoietin-resistant erythroid aplasia in immunosuppressed patients. This case report describes two male renal transplant recipients who infected HPV B19 after kidney transplantation with severe anemia. Rapid and severe anemia that did not respond to blood transfusion. Adjustment of immunosuppressive drugs and intravenous immunoglobulin treatment resolved severe anemia after two months. In conclusion, when anemia develops rapidly and severely in renal transplant recipients in the absence of rejection and hemolysis, parvovirus B19 infection should be considered.