Iron deficiency and hematological changes in adult patients after Fontan operation

Tomkiewicz‐Pająk, Lidia; Płazak, Wojciech; Kołcz, Jacek; Pająk, Jacek; Kopeć, Grzegorz; Dłużniewska, Natalia; Olszowska, Maria; Moryl-Bujakowska, A; Podolec, Piotr

doi:10.1016/j.jjcc.2014.02.021

Cited by 34 publications

(28 citation statements)

References 25 publications

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“…Factors that could confound the association include diurnal variation in serum iron levels [51–56] and unmeasured changes in iron and haematological parameters in the timeframe between entry into the study and endpoint determination. Several studies have reported positive correlations between serum iron or SF levels with TS, MCV and MCH [57, 58], whilst others have shown no significant correlation between MCV with TS and SF [59, 60]. …”

Section: Discussionmentioning

confidence: 99%

A prospective cohort examination of haematological parameters in relation to cancer death and incidence: the Busselton Health Study

et al. 2018

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BackgroundCancer risk is associated with serum iron levels. The aim of this study was to evaluate whether haematological parameters reflect serum iron levels and may also be associated with cancer risk.MethodsWe studied 1564 men and 1769 women who were enrolled in the Busselton Health Study, Western Australia. Haematological parameters evaluated included haemoglobin (Hb), mean cell volume (MCV), mean cell haemoglobin (MCH) and mean cell haemoglobin concentration (MCHC) and red cell distribution width (RCDW). Statistical analyses included t-tests for quantitative variables, chi-square tests for categorical variables and Cox proportional hazards regression modelling for cancer incidence and death.ResultsThere was marginal evidence of an association between MCV (as a continuous variable) and non-skin cancer incidence in women (HR 1.15, 95% CI 1.013, 1.302; p = 0.030) but the hazard ratio was attenuated to non-significance after adjustment for serum ferritin (SF), iron and transferrin saturation (TS) (HR 1.11, 95% CI 0.972, 1.264; p = 0.126). There was strong evidence of an association between MCHC and prostate cancer incidence in men; the estimated hazard ratio for an increase of one SD (0.5) in MCHC was 1.27 (95% CI 1.064, 1.507; p = 0.008). These results remained significant after further adjustment for SF and iron; the estimated hazard ratio for an increase of one SD (0.5) in MCHC was 1.25 (p = 0.014, 95% CI 1.05 to 1.48).ConclusionsThe MCHC and MCV were associated with cancer incidence in a Western Australian population, although only MCHC remained associated with prostate cancer after adjusting with serum iron and TS (circulating iron) and SF (storage iron). Haematological parameters are thus of limited utility in population profiling for future cancer risk.

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Section: Discussionmentioning

confidence: 99%

A prospective cohort examination of haematological parameters in relation to cancer death and incidence: the Busselton Health Study

et al. 2018

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“…20 Previous evidence was brought that an inverse association exists between anisocytosis and oxygen saturation of blood, thus meaning that the higher the RDW value, the lower the oxygen availability in peripheral tissues. 21 Interestingly, increased anisocytosis was found to be associated with reduced red blood cell deformability, 22 thus implying that the erythrocytes of patients with high RDW value may enter less efficiently the microcirculation, ultimately reducing oxygenation in peripheral organs. Another potential mechanism linking anisocytosis to ischemic damage may be found in the inhibition of nitric oxide bioactivity, which was shown to be considerably enhanced in the presence of anisocytosis, 23 ultimately resulting in reduced flow-dependent artery dilatation.…”

Section: Discussionmentioning

confidence: 99%

Red Blood Cell Distribution Width Is an Independent Predictor of Outcome in Patients Undergoing Thrombolysis for Ischemic Stroke

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et al. 2016

Semin Thromb Hemost

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An appropriate and timely management, including early diagnosis and accurate prognostication, is the mainstay for managed care of patients with acute ischemic stroke. Since red blood cell distribution width (RDW) was found to be an independent predictor of clinical outcomes in patients with thrombotic disorders, we designed a retrospective observational study to investigate whether the RDW value may also retain predictive significance in stoke patients undergoing thrombolytic therapy. This retrospective study was based on all patients admitted to the Emergency Department (ED) of the University Hospital of Verona (Italy) with a diagnosis of ischemic stroke, who underwent systemic thrombolysis between January 2013 and June 2015. The RDW value along with basal clinical characteristics was recorded at ED admission. The final study population consisted of 316 patients. A significant association was found between stroke severity (NIHSS score) and RDW ( = 0.322; < 0.001). The median RDW value in patients with clinical improvement after thrombolysis was significantly lower than in patients without (13.4 vs. 14.1%; < 0.001). The diagnostic accuracy (area under the curve) of RDW for predicting the lack of neurological improvement was 0.667. In univariate analysis, RDW >14.5% was associated with increased rate of no neurological improvement (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.37-4.13), an association remaining significant also in multivariate analysis (OR, 1.85; 95% CI, 1.13-3.32). Survivor curve analysis showed that patients with RDW values ≥14.5% had a higher risk of 1-year mortality and shorter survival. These results suggest that RDW assessment at ED admission may provide valuable diagnostic and prognostic information in patients with acute ischemic stroke.

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“…It has been reported that iron deficiency anemia is the most common type of anemia in adult Fontan patients, which correlates with lower exercise capacity. 12 As such, sickle cell disease patients fail to maintain an effective pulmonary blood flow to compensate for anemia, which would result in exercise limitation. 13 Long-term hepatic venous congestion in Fontan patients is a major cause for liver failure.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, it was found that the principal factor determining the level of ferritin in Fontan patients was the ALT levels and an increased level of ferritin concentration (>1.5 Â upper limit of the normal value) is an independent marker of liver damage. 12 Finally, there is increasing evidence that pulmonary artery hypertension could be a chronic complication of sickle cell disease, thalassemia, and other causes of chronic hemolytic anemia. 14 With this background, it would be informative to see how patients with sickle cell disease undergoing single ventricle alliation would behave clinically in the long run.…”

Section: Discussionmentioning

confidence: 99%

Staged Single Ventricle Palliation and Homozygous Sickle Cell Disease

et al. 2016

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Hypoxemia is a well-known trigger for precipitating a sickling crisis in patients with sickle cell disease. Patients undergoing staged single ventricle palliation have hypoxemia during the initial stages of the Fontan pathway. The successful completion of staged single ventricle palliation in a child with a combination of homozygous sickle cell disease and a single ventricle physiology that tolerate prolonged hypoxemia during earlier stages of Fontan pathway is described.

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Iron deficiency and hematological changes in adult patients after Fontan operation

Cited by 34 publications

References 25 publications

A prospective cohort examination of haematological parameters in relation to cancer death and incidence: the Busselton Health Study

A prospective cohort examination of haematological parameters in relation to cancer death and incidence: the Busselton Health Study

Red Blood Cell Distribution Width Is an Independent Predictor of Outcome in Patients Undergoing Thrombolysis for Ischemic Stroke

Staged Single Ventricle Palliation and Homozygous Sickle Cell Disease

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