UNASSIGNED: Castleman disease is a rare condition characterised by polytypic lymphocytes proliferation and lymphadenopathy generally with a benign course. Whereas high grade lymphoma (Richter syndrome) is a classical complication seen in chronic lymphocytic leukaemia with a poor outcome, benign conditions mimicking this entity are infrequent.
UNASSIGNED: We describe the case of an 81-year-old Caucasian male who developed a human herpesvirus-8 (HHV-8)-negative, idiopathic multicentric Castleman disease (iMCD) following a treated Binet C chronic lymphocytic leukaemia (CLL). The clinical and radiological pattern raised initially the suspicion of a classical Richter transformation. Blood analysis showed auto-immune haemolytic anaemia and thrombocytopenia. He had normal immunoglobulin levels. The anatomopathological analysis of a cervical adenomegaly showed hypervascularisation and a polytypic plasmocytic proliferation compatible with a plasmocytic iMCD type. Interestingly, bone marrow examination showed reticuline fibrosis but, in the absence of anasarca or generalised oedema, we were not allowed to conclude to the diagnosis of a TAFRO syndrome. We excluded all other mimicking conditions, comprising haematological malignancies, infections, and auto-immune diseases He was first treated with corticosteroids with poor results but dramatically responded to tocilizumab (anti-Il6).
UNASSIGNED: To our knowledge, this the first case described of a Castleman disease following CLL and surprisingly mimicking Richter syndrome. Clinicians should be aware of this rare misleading condition.
CONCLUSIONS: Castleman disease can mimic a Richter transformation in a CLL patient.

UNASSIGNED: Warm autoimmune haemolytic anaemia (wAIHA) is an acquired haemolytic disorder most commonly treated with a combination of corticosteroids, rituximab and/or splenectomy. Third-line therapies for refractory cases include immunosuppressive agents. Mycophenolate mofetil is frequently used in these scenarios, although its use is supported by small studies and anecdotal evidence rather than large-scale data.
UNASSIGNED: We describe three cases of refractory warm autoimmune haemolytic anaemia successfully treated with mycophenolate mofetil. Case 1: A persistent case of autoimmune haemolytic anaemia in a 56-year-old was ultimately managed with mycophenolate mofetil, leading to successful steroid tapering and stable haemoglobin levels without relapse. Case 2: A woman with a complex oncological history, including lymphoma and breast cancer, achieved remission with mycophenolate therapy, maintaining stability post-steroid treatment. Case 3: Mycophenolate proved effective for a 63-year-old with cirrhosis after recurrent autoimmune anaemia and deep vein thrombosis, enabling cessation of steroids and maintaining remission.
UNASSIGNED: Management of this condition can be challenging and balancing the available treatments is crucial to reduce potential complications from long-term therapies that appear to be ineffective. Our case series demonstrates anecdotal experience on successful use of mycophenolate mofetil for complex refractory cases of wAIHA.
CONCLUSIONS: Warm autoimmune haemolytic anaemia can be a challenging condition to manage. Refractory cases that are steroid-dependent can benefit from trialling steroid-sparing agents such as mycophenolate.Anti-CD20 agents such as rituximab can be very effective in refractory cases, however there is a small percentage of patients that might not be responsive to this monoclonal antibody.Autoimmune haemolytic anaemias can be frequently complicated by thrombotic events, and part of the backbone treatment is establishing good thromboprophylaxis.

Pica is an eating disorder defined as the compulsive and repeated ingestion of substances that have no nutritional value for at least one month. This condition may be hard to diagnose without complications, as a high degree of suspicion is needed. The subject in this case was a teenager who presented with asthenia and unspecific abdominal pain. The etiological workup showed no abnormalities other than mild anemia and iron and folate deficiencies. After a thorough anamnesis, the patient\'s mother mentioned sporadic ingestion of synthetic mattress foam since childhood, which had become more frequent in the previous year. With this key information, it was possible to establish a diagnosis before serious complications occurred and thus help the patient get the necessary assistance by referring them to pediatrics, nutrition, and child and adolescent psychiatry consultations. This case report highlights the importance of a detailed anamnesis, particularly when dealing with unspecific symptoms, exploring the possibility of disorders that are rarely thought of, such as pica. It also recaps how important it is to address sensitive topics like eating disorders and create an open environment with no judgment, as these attitudes are crucial to ensuring the correct diagnosis and providing the best care for patients.

OBJECTIVE: This study examined the prevalence, severity and risk factors of anaemia among adult people living with HIV attending an antiretroviral therapy centre in Woreta Primary Hospital, Woreta town, Ethiopia.
METHODS: Hospital-based retrospective cross-sectional study.
METHODS: Public health facility that provides HIV care in Woreta town.
METHODS: A total of 289 medical records of adults living with HIV/AIDS on highly active antiretroviral therapy from February 2019 to September 2023 at government hospital were reviewed using a systematic sampling method. The data were entered using Epi-info V.7 and exported to SPSS V.23 for data analysis. The data were analysed using bivariate and then multivariate logistic regression models in order to identify variables associated with anaemia. At the 95% CI level, variables having a p value of <0.05 were deemed to be statistically significant predictors.
METHODS: Prevalence and severity of anaemia and its predictors among adult patients living with HIV on antiretroviral therapy in Woreta Primary Hospital.
RESULTS: The total prevalence of anaemia was 31.5% (95% CI 28.9 to 33.8). The prevalence of mild, moderate and severe anaemia was 20.42%, 10.38% and 0.70%, respectively. Predictors independently linked with anaemia were female sex (adjusted OR (AOR) 1.08), age ≥40 years (AOR 1.21), lived with HIV >10 years (AOR 2.31), CD4 counts <200 cells/µL (AOR 3.81), non-suppressed viral load (AOR 1.28), history of opportunistic infections (AOR 1.54), WHO clinical stages III and IV (AOR 1.37 and 2.23, respectively) and history of parasitic infestation (AOR 2.81).
CONCLUSIONS: A sizeable proportion of participants were found anaemic. Female sex, older age, longer periods lived with the virus, lower CD4 count, non-suppressed viral load, history of opportunistic infections, WHO clinical stages III and IV and history of parasitic infestation were the contributing factors. Therefore, to improve the anaemic status and living circumstances of patients living with HIV, immediate action on the linked factors is needed, such as monitoring for maintenance of CD4 counts >200 cells/μL and avoiding progression of HIV to the advanced WHO clinical stages, suppressed viral load, preventing opportunistic infections and parasitic infestation.

Iron deficiency and iron deficiency anaemia are frequently under-recognised in chronic conditions with non-specific symptoms, including fatigue. This study aimed to assess the prevalence of iron deficiency with or without anaemia in chronic pain patients, and the association between iron deficiency status, fatigue and health-related quality of life. Eighty-two patients attending chronic pain outpatient appointments were recruited into this cross-sectional study. Iron studies and haemoglobin were determined from venous blood samples. Participants\' health-related quality of life was assessed with the 36-item short form survey and fatigue with the functional assessment of chronic illness therapy fatigue scale. Iron deficiency was prevalent in 58.8% of patients and 2.5% met the criteria for iron deficiency anaemia. There was no significant association between iron deficiency status and the functional assessment of chronic illness therapy fatigue scale score or 36-item short form survey domain scores. There was a high prevalence of iron deficiency in this group of chronic pain patients, while the prevalence of iron deficiency anaemia was low. There was no statistically significant association found between iron deficiency status and fatigue or quality of life measures.

UNASSIGNED: Anaemia is associated with reduced quality of life and increased mortality risk among people living with HIV (PLHIV). Although antiretroviral therapy (ART) reduces the prevalence of anaemia, some patients remain at risk after commencing ART.
UNASSIGNED: We estimated the incidence of anaemia after ART commencement and identified associated risk factors.
UNASSIGNED: We analysed outpatient records at Newlands Clinic, Harare, Zimbabwe. Patients (≥ 5 years old) who were commenced on ART between January 2016 and December 2020 were included and were followed up for up to 2 years. Patients with anaemia at ART commencement and women who were pregnant at any time during follow-up were excluded. Cox proportional hazards regression was used to assess independent risk factors for anaemia.
UNASSIGNED: During the study, 1110 patients ≥ 5 years old were commenced on ART with a prevalence of anaemia of 40.0%. Five hundred and twenty-nine patients met the inclusion criteria and were followed up for 823.7 person-years. The median age was 36.1 years and 290 (58.4%) were female. The incidence rate of anaemia after ART commencement was 176.1 per 1000 person-years (95% confidence interval [CI]: 149.6-207.2). Females (aHR: 2.09; 95% CI: 1.46-3.00, P < 0.001), zidovudine use (aHR: 3.50 96% CI: 2.14-5.71, P < 0.001), age 5-12 years or > 50 years, and the presence of World Health Organization stage III/IV disease (aHR: 2.19; 95% CI: 1.14-5.71, P = 0.019) had higher odds of developing anaemia.
UNASSIGNED: The incidence of anaemia after ART commencement was high. Female sex, zidovudine use, age and the presence of stage III/IV disease were independent risk factors for anaemia. Clinicians should screen PLHIV on ART regularly for anaemia.

UNASSIGNED: Anaemia is one leading cause of morbidity among adolescent girls. Prevention, early detection, and treatment can break the intergeneration cycle of malnutrition.
UNASSIGNED: The aim of the study was to estimate the prevalence of anaemia and assess its sociodemographic determinants and understand its association with the dietary pattern of rural adolescent girls.
UNASSIGNED: A cross-sectional study was conducted among 350 adolescent girls studying in the school of Kalgatigi Taluk, Dharwad district. The school girls were interviewed using a predesigned structured questionnaire by interview method. A food frequency questionnaire was used to assess the dietary pattern. Haemoglobin levels were estimated using Sahli\'s method.
UNASSIGNED: Data were entered in Microsoft Excel and analysed using SPSS version 19 and the Chi-square test was applied to study the significance.
UNASSIGNED: Rural adolescent school girls between the age group of 13-16 years were included. The prevalence of anaemia among them was found to be 47.4% and was significantly associated with the educational status of the mother, their socioeconomic status (SES), and type of diet. Vegetarian girls had a higher prevalence of anaemia. The frequency of meat and egg consumption was significantly associated with anaemia. The prevalence of anaemia was higher in thin and severely thin girls based on WHO-BMI.
UNASSIGNED: Anaemia in rural adolescent girls is of high burden and public health importance with a prevalence of 47.4% and significant association with dietary habits, SES, and BMI.

BACKGROUND:  Red blood cell (RBC) transfusion is one of the most critical and expensive lifesaving treatment modalities. A clinical audit is a valuable instrument to determine whether transfusion practices align with the guidelines and identify knowledge deficiencies. The study aimed to evaluate the RBC transfusion practices and patient outcomes at the National District Hospital in Bloemfontein, South Africa, and to determine adherence to transfusion guidelines.
METHODS:  A retrospective descriptive study was conducted. All blood transfusion registers in the hospital were used to identify transfusion episodes during the study period. Files were retrieved from the admissions office and information captured on a paper-based datasheet. The appropriateness of the transfusion and adherence to the South African transfusion guidelines were evaluated using specific criteria.
RESULTS:  Of the 118 transfusion episodes during the study period, 78 files were retrieved and 76 included in the study. The patients\' median age was 47 years (interquartile range [IQR]: 32-66 years), with human immunodeficiency viruses (HIV) (n = 34; 44.7%) being the most common comorbid condition. Pre-transfusion haemoglobin was documented for all patients with a median of 4.6 g/dL (IQR: 3.95 g/dL - 5.5 g/dL). The audit revealed that in 68.4% (n = 52) of the cases, the guidelines were applied appropriately.
CONCLUSIONS:  The study described the blood transfusion practices and identified shortcomings when compared with the standard clinical guidelines.Contribution: The study highlights the importance of applying rationale, caution and consideration of the specific patient profile when performing transfusions.

Anaemia is a common health problem worldwide that disproportionately affects vulnerable groups, such as children and expectant mothers. It has a variety of underlying causes, some of which are genetic. A comprehensive strategy combining physical examination, laboratory testing (for example, a complete blood count), and molecular tools for accurate identification is required for diagnosis. With nearly 400 varieties of anaemia, accurate diagnosis remains a challenging task. Red blood cell abnormalities are largely caused by genetic factors, which means that a thorough understanding requires interpretation at the molecular level. As a result, precision medicine has become a key paradigm, utilising artificial intelligence (AI) techniques, such as deep learning and machine learning, to improve prognostic evaluation, treatment prediction, and diagnostic accuracy. Furthermore, exploring the immunomodulatory role of vitamin D along with biomarker‑based molecular techniques offers promising avenues for insight into anaemia\'s pathophysiology. The intricacy of aplastic anaemia makes it particularly noteworthy as a topic deserving of concentrated molecular research. Given the complexity of anaemia, an integrated strategy integrating clinical, laboratory, molecular, and AI techniques shows a great deal of promise. Such an approach holds promise for enhancing global anaemia management options in addition to advancing our understanding of the illness.

OBJECTIVE: Renin-angiotensin system inhibitors (RASi) have been shown to lower haemoglobin levels, potentially related to reductions in erythropoietin levels and haematopoiesis. We examined whether sacubitril/valsartan might attenuate this effect of RASi alone on incident anaemia in patients with heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF).
RESULTS: PARAGON-HF was a global, multicentre randomized clinical trial of sacubitril/valsartan versus the RASi valsartan in patients with HF and left ventricular ejection fraction ≥45%. We evaluated haemoglobin trajectory and risks of incident anaemia and new iron therapy initiation during follow-up. Among 4795 participants, 1111 (23.2%) had anaemia at randomization and 5.6% were treated with iron at baseline. Over a median follow-up of 2.9 years, patients with anaemia were at significantly higher risk for total HF hospitalizations and cardiovascular death, compared with those without anaemia (21.6 vs. 11.5 per 100 patient-years; adjusted rate ratio 1.31; 95% confidence interval [CI] 1.12-1.54; p = 0.001). Sacubitril/valsartan slightly slowed the decline in haemoglobin levels by 0.1 g/dl (95% CI 0.0-0.2 g/dl; p = 0.005). Participants treated with sacubitril/valsartan were at significantly lower risk of developing anaemia (30.3% vs. 37.6%; hazard ratio [HR] 0.76; 95% CI 0.68-0.85; p < 0.001) and starting iron therapy (8.1% vs. 10.0%; HR 0.81; 95% CI 0.67-0.97; p = 0.026). Treatment effects of sacubitril/valsartan versus valsartan on total HF hospitalizations and cardiovascular death were consistent among patients across the haemoglobin spectrum (pinteraction = 0.60).
CONCLUSIONS: Among patients with HFmrEF/HFpEF, treatment with sacubitril/valsartan resulted in modestly smaller declines in haemoglobin, lower rates of incident anaemia, and fewer new initiations of iron therapy compared with RASi.
BACKGROUND: ClinicalTrials.gov ID NCT01920711.