ObjectiveTo systematically review the pharmacoeconomics of high-dose intravenous iron ferric carboxymaltose in the treatment of patients with iron deficiency anemia. MethodsPharmacoeconomic studies of ferric carboxymaltose in the treatment of patients with iron deficiency anemia were searched in PubMed, The Cochrane Library, York University CRD, Web of Science, EBSCO, CNKI, WanFang Data and VIP databases, and relevant health technology assessment websites from inception to September 30th, 2021. A descriptive analysis was performed after two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. ResultsA total of 11 studies were included, most of them compared the health economics of ferric carboxymaltose with other therapies from a hospital perspective. The main costs included in these studies were costs for iron, infusion, blood transfusion, EPO, hospitalization, and transportation, as well as productivity cost. The ferric carboxymaltose was presumed to be more economical than other intravenous irons. ConclusionIt is suggested that the ferric carboxymaltose be considered in more clinical settings to improve the ischemic condition of patients with iron deficiency anemia, so as to promote the rational utilization of medical resources.
Objective To assess the effectiveness and safety of erythropoietin (EPO) for cancer-related malignant anemia without radiotherapy or chemotherapy. Methods Randomized controlled trials (RCTs) or quasi-randomized controlled trials (quasi-RCTs) involving erythropoietin in the treatment of cancer-related malignant anemia were searched and identified from PubMed (1966 to Sept. 2009), EMBASE (1974 to Sept. 2009), The Cochrane Library (Issue 3, 2009), CBM (1978 to Sept. 2009), CNKI (1994 to Sept. 2009), VIP (1989 to Sept. 2009). We also handsearched relevant journals. Data were extracted and evaluated by two reviewers independently with specially designed extraction form. We evaluated the quality of the included studies by the Cochrane Handbook 5.0 recommend standard and analyzed data by Cochrane Collaboration’s RevMan 5.0. Results We included twelve trials. The quality of the included studies was poor. The grade of ten studies was B, and the grade of two studies was C. Meta-analyses showed that there were significant differences between erythropoietin and blank in volume of blood transfusion [SMD= –0.66, 95%CI (–1.14, –0.17), P=0.008], number need to transfusion [OR=0.60, 95%CI (0.39, 0.92), P=0.02], and the change of hemoglobin after two-week therapy [SMD=2.40, 95%CI (0.29, 4.52), P=0.03]. Conclusion The current evidence shows that EPO significantly benefits cancer-related malignant anemia. Well-designed RCTs with a larger sample size, longer intervention and follow-up periods are still needed.
Studies of evidence-based medicine have provided much important evidence, clarified problems, and guided the clinical practice in the treatment of renal diseases. As examples, several therapeutic problems in renal hypertension, renal anemia and low protein diet for the patients with chronic kidney disease are discussed in this paper.
ObjectiveTo investigate the clinical features, diagnosis, treatment and prognosis of pulmonary tumor thrombotic microangiopathy (PTTM).MethodsA patient with PTTM was reported. Literatures about PTTM searched by WanFang databases and PubMed were reviewed for its clinical characteristics.ResultsA 62-year-old female was admitted with chief complaint of dry cough, dyspnea and hemoptysis. Progressive dyspnea, pulmonary hypertension and hypoxemia occurred during hospitalization. Computed tomography angiography (CTA) of the lung excluded pulmonary embolism. Peripheral blood appearing a large number of late erythroblasts and erythrocyte debris and progressively decreasing platelets suggested that the patient suffer from thrombotic microvascular disease. CT showed widely metastatic lesions at the vertebrae and sternum. On the basis of above clinical characteristics, PTTM was diagnosed clinically. Although the patient accepted respiratory support therapy, anticoagulation therapy and resuscitation, she still died 5 days later after hospitalization. Literatures about PTTM with complete clinical information were reviewed. A total of 92 PTTM cases were reviewed and the main reasons of these patients admitted were progressive dyspnea and chronic cough. During hospitalization, they all suffered varying degrees of hypoxia, while radiological findings of the lungs lack specificity. No abnormal sighs were found by lung CTA. The results of ultrasonic cardiography or the Swan–Ganz catheter indicated varying degrees of pulmonary hypertension, some patients were proved with disseminated intravascular coagulation and/or microangiopathic hemolytic anemia. The definite diagnosis of PTTM depended on the histologic evidence which were often obtained from post-mortem examination, because many patients couldn’t tolerate the lung biopsy due to rapid aggravation. The treatment of PTTM included respiratory support therapy, anticoagulation therapy, antipulmonary hypertension and the chemotherapy of primary or metastatic tumour. The prognosis of PTTM was poor and almost all of the patients died in a short term, ranged from 48 hours to 3 months.ConclusionIf a patient with a history of cancer or evidence of cancer metastasis has hypoxemia and pulmonary hypertension but without abnormal lung CTA signs, PTTM should be considered.
Objective To asses the clinical effectiveness and safety of combined treatment with antilymphocyte globulin (ATG) and cyclosporine A (CSA) versus antilymphocyte globulin alone in patients with aplastic anemia (AA). Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1966 to September 2007), EMBASE (1984 to September 2007), The Cochrane Library (issue 4, 2007) and CBM-disc (1978 to September 2007). The references of eligible studies were hand searched. RCTs involving ATG and CSA in the treatment of AA were included. Data were evaluated and extracted by two reviewers independently with designed extraction form. The Cochrane Collaboration’ s RevMan 4.2.10 software was used for data analyses. Results Two RCTs involving 160 patients were included. Two studies showed that the effective rate in the ATG+CSA group was significantly higher than that in the ATG group (Plt;0.0001). Two studies indicated that the survival rate in the ATG+CSA group was improved compared with the ATG group (P=0.0002). One study reported adverse effect. The ATG group caused more fever and serum diseases compared with the ATG+CSA group, but the ATG+CSA group had a higher incidence of hepatotoxicity. Conclusion Treatment with ATG+CSA for aplastic anemia has higher effective rate and survival rate than ATG alone. More trials of high quality are required.
Objective To assess the clinical effectiveness and safety of astragalus injection plus androgen versus androgen alone for patients with aplastic anemia (AA). Methods Such databases as The Cochrane Library (Issue 3, 2011), PubMed (1966 to March 2011), EMbase (1974 to March 2011), CNKI (1994 to March 2011), VIP (1989 to March 2011) and Wanfang Data (1997 to March 2011) were searched to include the randomized controlled trails (RCTs) according to the inclusive and exclusive criteria. The data were extracted, the quality was assessed, and meta-analysis was conducted by using Revman5.0.24 software. Results Seven RCTs involving 518 patients with AA were included. The meta-analysis showed that the astragalus plus androgen treatment group was superior to the androgen alone group in the total effective rate with significant difference (OR=3.12, 95%CI 2.09 to 4.66, Plt;0.000 01); the adverse events in the treatment group were fewer than those in the control group with significant difference (OR=0.30, 95%CI 0.12 to 0.76, P=0.01); but the promotion degree of myelosis between the two groups was similar without significant difference (OR=1.93, 95%CI 0.85 to 4.38, P=0.11). Conclusion The astragalus plus androgen treatment is superior to the androgen alone treatment in the total effective rate and fewer adverse events. More high-quality trails are required to verify this conclusion due to the low quality and small scale of the included studies.
ObjectiveTo analyze the clinical effect of sodium chlorophyllin in the treatment of geriatric oncology-related anemia and its significance. MethodsWe retrospectively analyzed the clinical data of elderly cancer patients with similar treatment background between December 2011 and February 2013, and the patients were divided into sodium chlorophyllin treatment group and no special treatment group. Then, parallel comparative study was carried out for anemia-related indexes and scores of quality of life. ResultsHemoglobin, red blood cells and quality of life of sodium chlorophyllin treatment group were improved after treatment, and these indexes were also better than those in the no special treatment group (P<0.05). ConclusionSodium chlorophyllin can ameliorate anemia in elderly patients with oncology-related anemia, which is worthy of being popularized.
Autoimmune hemolytic anemia (AIHA) is an autoimmune disease in which the life span of red blood cells is shortened by red blood cell autoantibodies. Due to immune intolerance and abnormal immune regulation, the hyperfunction of B lymphocytes produces too many red blood cell autoantibodies. Anti-CD20 monoclonal antibody is a second-line drug for warm antibody AIHA and first-line drug for cold antibody AIHA by reducing B lymphocytes. At present, the optimal dose of anti-CD20 monoclonal antibody in the treatment of AIHA has not been determined. There are no reports on the treatment of primary AIHA with second- or third-generation anti-CD20 monoclonal antibodies.
Objective To investigate the effectiveness of recombinant human erythropoietin (rHuEPO) combined with iron in treatment of anemia in elderly patients with intertrochanteric fractures during perioperative period. Methods A clinical data of 71 patients with intertrochanteric fractures met the inclusion criteria between April 2016 and October 2017 was retrospectively analyzed. All patients were treated with closed reduction and proximal femoral intramedullary nail fixation. Thirty-one patients were treated with rHuEPO and iron before operation as trial group, and 40 patients were not treated with rHuEPO and iron as control group. There was no significant difference in gender, age, body mass index, cause of injury, fracture side and classification, American Society of Anesthesiologists (ASA) classification, combined medical diseases, time from fracture to admission, preoperative hospital stay, and operation time between the two groups (P>0.05).The hemoglobin levels before operation and at 1, 3, and 7 days after operation, number of blood transfusion, blood transfusion rate, blood transfusion volume, postoperative hospital stay, complications were recorded and compared. Results After operation, 8 patients (25.8%) in trial group and 22 patients (55.0%) in control group received blood transfusion; the blood transfusion volume was (1.96±0.85) units in trial group and (3.19±1.61) units in control group. There were significant differences in blood transfusion rate and volume between the two groups (P<0.05). There was no significant difference in preoperative hemoglobin level between the two groups (P>0.05). The postoperative hemoglobin level was higher in trial group than in control group, and the difference between the two groups was significant at 7 days (P<0.05). The postoperative hospital stay was (6.16±3.97) days in trial group and (9.25±4.47) days in control group, showing significant difference between the two groups (P<0.05). There were 8 patients (25.8%) with pulmonary infection in trial group and 14 (35.0%) in control group after operation; 6 patients (19.4%) with deep venous thrombosis in trial group and 8 (20.0%) in control group. There was no significant difference in the incidences of complications between the two groups (P>0.05). All patients were discharged from hospital normally, and no one died during hospitalization. Conclusion The application of rHuEPO combined with iron before operation in elderly patients with intertrochanteric fractures can rapidly increase the hemoglobin level after operation, shorten the hospital stay, and do not increase the risk of deep venous thrombosis after operation.
ObjectiveTo investigate the incidence of perioperative anemia and the influencing factors of preoperative anemia in patients with colorectal cancer.MethodsThe clinicopathological data of 1 250 patients with colorectal cancer who underwent surgery in our hospital from January 1, 2019 to December 31, 2019 were analyzed retrospectively. According to the preoperative hemoglobin level, patients were divided into anemia group and non-anemia group. Univariate analysis and multivariate logistic regression analysis were used to explore the influencing factors of preoperative anemia in patients with colorectal cancer, and the effects of preoperative anemia on intraoperative blood transfusion, postoperative complications, and postoperative hospital stay were analyzed.ResultsThe incidence of preoperative anemia in patients with colorectal cancer was 40.6% (508/1 250), and the incidence of preoperative anemia in patients with right colon cancer, left colon cancer, and rectal cancer was 66.0% (192/291), 41.1% (139/338), and 28.5% (177/621), respectively. The incidence of postoperative anemia in patients with colorectal cancer was 69.4% (867/1 250), and the incidence of postoperative anemia in patients with right colon cancer, left colon cancer, and rectal cancer was 81.8% (238/291), 68.9% (233/338), and 63.8% (396/621), respectively. Multivariate logistic regression analysis showed that age >60 years old, nutritional risk screening 2002 ≥3, right colon cancer, T3–4 stage, and M1 stage were risk factors for preoperative anemia in patients with colorectal cancer (P<0.05). The rate of intraoperative blood transfusion and the incidence of postoperative complications in the preoperative anemia group of patients with colorectal cancer were higher than those in the non-anemia group (P<0.05). The postoperative hospital stay in the preoperative anemia group of patients with colon cancer was longer than that in the non-anemia group (P<0.05).ConclusionsThe incidence of perioperative anemia in patients with colorectal cancer is high. Advanced age, high nutritional risk, right colon cancer, T3–4 stage, and distant metastasis were the risk factors of preoperative anemia in patients with colorectal cancer. Preoperative anemia can increase the demand for intraoperative blood transfusion and the incidence of postoperative complications in patients with colorectal cancer, and prolong postoperative hospital stay of colon cancer patients.