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How 217 Pediatric Intensivists Manage Anemia at PICU Discharge: Online Responses to an International Survey*
Objective: To describe the management of anemia at PICU discharge by pediatric intensivists. Design: Self-administered, online, scenario-based survey. Setting: PICUs in Australia/New Zealand, Europe, and North America. Subjects: Pediatric intensivists. Interventions: None. Measurements and Main Results: Respondents were asked to report their decisions regarding RBC transfusions, iron, and erythropoietin prescription to children ready to be discharged from PICU, who had been admitted for hemorrhagic shock, cardiac surgery, craniofacial surgery, and polytrauma. Clinical and biological variables were altered ...
Source: Pediatric Critical Care Medicine - June 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Fatal iron toxicity in an adult: Clinical profile and review
We report an instance wherein an adult committed suicide by ingestion of multiple iron tablets. Delay in treatment was there due to misdiagnosis of the intoxicating agent. She developed fulminant hepatic failure with rapid clinical deterioration. Despite aggressive supportive management, the patient succumbed to the toxic doses of iron. Clinical course and postmortem features are discussed with a review of the literature.
Source: Indian Journal of Critical Care Medicine - November 19, 2018 Category: Intensive Care Authors: Mandar Ramachandra Sane Kamal Malukani Rashmi Kulkarni Abhishek Varun Source Type: research

Suspecting Hyperferritinemic Sepsis in Iron-Deficient Population: Do We Need a Lower Plasma Ferritin Threshold?*
Conclusions: Ferritin rises significantly in septic shock patients despite iron deficiency and seems to correlate with the severity of inflammation and organ dysfunction. Even a lower threshold (of 500 or 1,000 ng/mL) could predict higher mortality. It may suggest the need for redefining the plasma ferritin threshold for suspecting hyperferritinemic sepsis and sepsis-induced macrophage activation syndrome in these patients. Larger studies with frequent ferritin measurements are desirable to validate these initial observations.
Source: Pediatric Critical Care Medicine - July 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Pediatric Screening: Development, Anemia, and Lead.
Abstract Screening and prevention are important components of general pediatric health care. Infants and young children should be screened for iron deficiency anemia, lead poisoning, and developmental disorders as essential parts of the well-child visit. Developmental and behavioral screening early in childhood is necessary to identify developmental delays and facilitate timely treatment. Lead screening is recommended for at-risk pediatric patients to treat children with elevated lead levels. Infants and children are also at risk for iron deficiency anemia and must be screened appropriately. Familiarization with p...
Source: Primary Care - February 3, 2019 Category: Primary Care Authors: Wood SK, Sperling R Tags: Prim Care Source Type: research

Prediction of Poor Outcomes for Septic Children According to Ferritin Levels in a Middle-Income Setting*
Objectives: To evaluate serum ferritin measured within 48 hours of admission as a prognostic marker and examine the association with unfavorable outcomes in a population of pediatric patients with sepsis and high prevalence of iron deficiency anemia in which this biomarker is routinely measured. Design: Retrospective cohort study. Setting: PICU of a tertiary care teaching hospital in a middle-income country in South America. Patients: All patients 6 months to 18 years old (n = 350) admitted with a diagnosis of sepsis, suspected or proven, were eligible for inclusion. Exclusion criteria were length of PICU stay l...
Source: Pediatric Critical Care Medicine - May 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Hepcidin and Anemia in Surgical Critical Care: A Prospective Cohort Study*
Objective: Because anemia of inflammation is common in ICU patients and hepcidin is the key regulator of iron homeostasis, we examined time-dependent changes in hepcidin, erythropoietin, iron, and inflammatory markers in surgical ICU patients with anemia. Design: Prospective single-center clinical noninterventional study. Setting: Surgical ICUs; U.S. university hospital. Patients: One hundred surgical adult ICU patients. Measurements and Main Results: Time-dependent changes in serum hepcidin, hematologic, and erythropoietic studies were performed on ICU admission and at serial time-points through day 28, and ...
Source: Critical Care Medicine - May 17, 2018 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

The Post-injury Inflammatory State and the Bone Marrow Response to Anemia.
CONCLUSIONS: Elective hip repair was associated with a mild neuroendocrine activation and an appropriate bone marrow response to anemia. Severe blunt trauma was associated with exaggerated neuroendocrine activation, erythropoietin dysfunction, iron dysregulation, erythroid progenitor growth suppression and persistent injury-associated anemia. Clinical trial registration available at www.clinicaltrials.gov, ID NCT02577731. PMID: 29768025 [PubMed - as supplied by publisher]
Source: American Journal of Respiratory and Critical Care Medicine - May 16, 2018 Category: Respiratory Medicine Authors: Loftus TJ, Mira JC, Miller ES, Kannan KB, Plazas JM, Delitto D, Stortz JA, Hagen JE, Parvataneni HK, Sadasivan KK, Brakenridge SC, Moore FA, Moldawer LL, Efron PA, Mohr AM Tags: Am J Respir Crit Care Med Source Type: research

The Transferrin Receptor CD71 Delineates Functionally Distinct Airway Macrophage Subsets during Idiopathic Pulmonary Fibrosis.
CONCLUSIONS: Taken together these data highlight how CD71 delineates AM subsets which play distinct roles in IPF and furthermore, CD71- AMs may be an important pathogenic component of fibrotic lung disease. PMID: 31051082 [PubMed - as supplied by publisher]
Source: American Journal of Respiratory and Critical Care Medicine - May 2, 2019 Category: Respiratory Medicine Authors: Allden SJ, Ogger PP, Ghai P, McErlean P, Hewitt R, Toshner R, Walker SA, Saunders P, Kingston S, Molyneaux PL, Maher TM, Lloyd CM, Byrne AJ Tags: Am J Respir Crit Care Med Source Type: research

Iron-ing Out the Roles of Macrophages in Idiopathic Pulmonary Fibrosis.
PMID: 31091960 [PubMed - as supplied by publisher]
Source: American Journal of Respiratory and Critical Care Medicine - May 14, 2019 Category: Respiratory Medicine Authors: O'Dwyer DN, Moore BB Tags: Am J Respir Crit Care Med Source Type: research

Tissue-specific Immunopathology in Fatal COVID-19.
CONCLUSIONS: Tissue-specific immunopathology occurs in Covid-19, implicating a significant component of immune-mediated, virus-independent immunopathology as a primary mechanism in severe disease. Our data highlight novel immunopathological mechanisms, and validate ongoing and future efforts to therapeutically target aberrant macrophage and plasma cell responses as well as promoting pathogen tolerance in Covid-19. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/). PMID: 33217246 [PubMed - as supplied by publisher]
Source: American Journal of Respiratory and Critical Care Medicine - November 20, 2020 Category: Respiratory Medicine Authors: Dorward DA, Russell CD, Um IH, Elshani M, Armstrong SD, Penrice-Randal R, Millar T, Lerpiniere CE, Tagliavini G, Hartley CS, Randle NP, Gachanja NN, Potey PM, Dong X, Anderson AM, Campbell VL, Duguid AJ, Al Qsous W, BouHaidar R, Baillie JK, Dhaliwal K, Wa Tags: Am J Respir Crit Care Med Source Type: research

Comfort Care, Whatever Does That Mean?
by Michael Pottash (@mpottash)Comfort Care, whatever does that mean? This is the important question asked by my colleagues Anne Kelemen and Hunter Groninger in the September 2018 issue of JAMA Internal Medicine. The term is ubiquitous and its interpretation influences how patients with end stage illness are cared for at the end of their lives. In their article they argue that the language of Comfort Care is confusing and easily misunderstood. They suggest improving the understanding around end of life care and moving to a less ambiguous term for care of the dying. I worry that any term to describe dying care will always be...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 4, 2019 Category: Palliative Care Tags: comfort hospice hospital icu JAMA Internal Medicine palliative care pottash The profession Source Type: blogs

Pediatric Screening
Screening and prevention are important components of general pediatric health care. Infants and young children should be screened for iron deficiency anemia, lead poisoning, and developmental disorders as essential parts of the well-child visit. Developmental and behavioral screening early in childhood is necessary to identify developmental delays and facilitate timely treatment. Lead screening is recommended for at-risk pediatric patients to treat children with elevated lead levels. Infants and children are also at risk for iron deficiency anemia and must be screened appropriately. Familiarization with pediatric screening...
Source: Primary Care: Clinics in Office Practice - December 22, 2018 Category: Primary Care Authors: Sarah K. Wood, Randi Sperling Source Type: research

Impact of iron deficiency diagnosis using hepcidin Mass Spectrometry dosage methods on hospital stay and costs after a prolonged ICU stay: study protocol for a multicentre, randomised, single-blinded medico-economic trial.
Discussion The results of this study will show whether diagnosing iron deficiency using MS hepcidin determination methods is liable to reduce patients’ post-ICU hospital stay and costs, as well as their anaemia and fatigue.
Source: Anaesthesia, Critical Care and Pain Medicine - September 15, 2017 Category: Anesthesiology Source Type: research

Utilization trends and safety of intravenous iron replacement in pediatric specialty care: A large retrospective cohort study
ConclusionsIV iron is commonly prescribed by certain pediatric specialties but there is little standardization in the indications, formulations, or dosing. These data suggest that IV iron should be considered a safe alternative for iron deficiency treatment in pediatrics when oral iron is either unsuccessful or contraindicated.
Source: Pediatric Blood and Cancer - January 25, 2018 Category: Cancer & Oncology Authors: Alexander A. Boucher, Amanda Pfeiffer, Ashley Bedel, Jennifer Young, Patrick T. McGann Tags: RESEARCH ARTICLE Source Type: research

Iron Parameters Determine the Prognosis of Critically Ill Patients*
Conclusions: Our findings demonstrate that parameters of iron metabolism, particularly transferrin saturation, that reflect serum iron availability, are strong outcome predictors in ICU patients. These data suggest that a failure of iron homeostasis with increased iron availability in serum occurs in lethally ill ICU patients and should trigger prospective clinical trials evaluating the usefulness of iron-chelating therapy in critical illness and sepsis.
Source: Critical Care Medicine - May 17, 2016 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research