갑상선기능저하증에 동반된 빈혈의 병태생리에 관한 연구

한지숙,이선주,이현철,민유홍,허갑범,고윤웅 大韓血液學會 1992 大韓血液學會誌 Vol.27 No.1

Maternal pre-pregnancy anemia and childhood anemia in Indonesia: a risk assessment using a population-based prospective longitudinal study

Fadila Wirawan,Dieta Nurrika 한국역학회 2022 Epidemiology and Health Vol.44 No.-

OBJECTIVES Anemia in children under 5 years of age is often overlooked despite its detrimental effects. The public health approach to anemia prevention includes the maternal pre-pregnancy phase. This study investigated the association between pre-pregnancy anemia and the risk of anemia in children under 5 years of age. METHODS This cohort study included non-pregnant women from the 2007 Indonesian Family Life Survey (IFLS) and their children under 5 in the 2014 IFLS. The anemia status of mothers and children was determined based on hemoglobin (Hb) levels using Hemocue. Mantel-Haenszel adjusted relative risks (aRRs), including risk stratification by covariates, were used for the final risk assessment. RESULTS In total, 637 children in the 2014 IFLS were included. The risk of having a child with anemia was 1.71-fold higher in women with pre-pregnancy anemia than in women without pre-pregnancy anemia (aRR, 1.71; 95% confidence interval [CI], 1.03 to 2.85). After risk stratification based on potential confounding variables, maternal pre-pregnancy anemia remained an independent risk factor for anemia in children who still breastfed at the time of data collection (relative risk [RR], 2.11; 95% CI, 1.16 to 3.86), in children who were given water earlier than 6 months of age (RR, 2.08; 95% CI, 1.20 to 3.61), in children of mothers with a normal or underweight pre-pregnancy body mass index (RR, 1.94; 95% CI, 1.20 to 3.14), and in children of mothers without current anemia (RR, 2.20; 95% CI, 1.21 to 3.99). CONCLUSIONS Pre-pregnancy anemia increased the risk of childhood anemia. A public health approach emphasizing pre-conception maternal health would enable better maternal and child morbidity risk prevention.

RDW를 이용한 빈혈의 재분류

황형기,심봉섭,현명수 영남대학교 의과대학 1993 Yeungnam University Journal of Medicine Vol.10 No.1

1986년 5월부터 1991년 6월까지 약 5년간 영남대학교 의과대학 부속병원에 내원하여 혈액학적 소견상 빈혈이 동반된 환자 210명과 정상인 200명 도합 410명을 대상으로 Coulter Counter S-plus Ⅱ로 일반혈액검사를 실시하여 MCV 와 RDW 및 여러 적혈구 지수를 얻어서 빈혈의 새로운 분류를 시도하였고 외국인에 비하여 빈혈의 병인 양상이 다른 한국인의 혈액질환의 감별진단에 도움이 되는가를 알아 보고자 본 연구를 시행하였다. 거의 모든 경우에 MCV의 증감은 MCH와 MCHC의 증감을 동반하였으나 RDW와는 무관 하였다. 따라서 저색소성빈혈 혹은 정색소성빈혈등의 용어보다는 이질성빈혈 혹은 동질성빈혈의 용어를 사용함이 빈혈의 형태학적 분류에 더욱 의미있는 것으로 사료되었다. 이질성소구성빈혈에는 철결핍성빈혈이 속하였고 이질성정구성빈혈에는 급성백혈병과 골수로성빈혈이 여기에 속하였으며 이질성대구성빈혈에는 거대적아구성빈혈과 용혈성빈혈이 속하였다. 동질성소구성빈혈에는 만성질환에 의한 빈혈이 여기에 속하였으며 동질성정구성빈혈에는 급성출혈, 만성백혈병 및 다발성골수종등에 의한 빈혈이 여기에 속하고 동질성대구성빈혈에는 재생불량성빈혈이 여기에 속하였다. 진단적인 의의가 큰 혈색소병은 본 연구에는 관찰되지 않았지만 한국인에 가장 많은 빈혈의 원인인 철결핍성빈혈과 만성질환에 의한 빈혈의 감별진단에 RDW가 유용한 것으로 생각되었다. The author obtained index of red cell volume distribution width(RDW) and other red cell indices in 210 patients of various hematoncologic conditions and 200 healthy control group using, an automated blood analyzer, Coulter Counter Model S-plus Ⅱ. This study performed to classify various etiologic anemia based on the MCV and RDW, to evaluate availability to the differential diagnosis in korean anemic disorders somewhat different from etiologies of anemias in foreginers. In the most of cases, the increase or decrease of MCV and RDW were always combined the pararell changes of MCH and MCHC. But the values of MCV and RDW were not correlated in control group and patient group. So the terms of heterogenous of homogenous anemia were meaningful morphologic classification than hypochromic or normochromic anemia. The heterogenous microcytic anemia contained iron deficiency anemia. In heterogenous normocytic anemia, myelophthisic anemia, acute leukemia were contained. In heterogenous macrocytic anemia, megaloblastic anemia, hemolytic anemia were contained. The homogenous microcytic anemia was observed in anemia of chronic disorders. In homogenous normocytic anemia, acute blood loss, chronic leukemia, multiple myeloma were contained. The aplastic anemia was belonged to homogenous macrocytic anemia. The diagnostic significance of RDW in hemoglobinopathies is most important. But this study was not contained hemoglobinopathies. Instead RDW was very helpful to differential diagnosis of most common anemias, iron deficiency anemia and anemia due to chronic disorders in Korea.

소아기 급성 감염성 질환에 동반된 빈혈에 관한 연구

이백길,김병연,김일경,성호,최창희 최신의학사 1991 最新醫學 Vol.34 No.8

Association between Anemia and Myopia in Korean Adults

서민이,박상신 한국보건정보통계학회 2023 보건정보통계학회지 Vol.48 No.4

Objectives: Anemia is a significant public health issue worldwide and has been associated with ocular changes. This study aimed to investigate the rela- tionship between anemia and myopia in an adult population in South Korea. Methods: We analyzed the data of 8,672 participants aged 20 to 54 years in the fifth Korea National Health and Nutrition Examination Survey (KNHANES). Anemia was defined as hemoglobin levels < 13 g/dL for men, < 12 g/dL for women, and < 11 g/dL for pregnant women. Anemia was subdivided into mild anemia (11-12.9 g/dL for men, 11-11.9 g/dL for women, and 10-10.9 g/dL for pregnant women) and moderate to severe anemia ( < 11 g/dL for men and women and < 10 g/dL for pregnant women) categories. Myopia was defined as spherical equivalent value ≤ -0.5 diopters. We performed multivariable logistic regression analysis to examine the relationship between anemia and myopia. Results: The prevalence of myopia was 43.5% in men and 56.5% in women. The prevalence of anemia was 0.9% in men and 14.5% in women. After adjusting for confounders, the risk of myopia was 1.28 times higher in women with anemia than in those without anemia (odds ratio, OR = 1.28, 95% confidence interval, CI = 1.02-1.60, p = 0.036). The risk of myopia was 1.55 times higher in women with moderate to severe anemia than in those without anemia (OR = 1.55, 95% CI = 1.12-2.16, p = 0.026). Anemia was not significantly associated with myopia in men. Conclusions: Women with ane- mia were at increased risk of myopia compared to those without anemia. The severity of anemia was also associated the risk of myopia.

급성기 노인전문병동에 입원한 노인성 질환 환자에서 관찰되는 빈혈의 임상적 의의

김은일 ( Eun Il Kim ),서예원 ( Ye Won Suh ),정수현 ( Su Hyun Jung ),김은영 ( Eun Young Kim ),김혜영 ( Hye Young Kim ),박명숙 ( Myung Sook Park ),유기동 ( Ki Dong Yu ),김광일 ( Kwang Il Kim ),김철호 ( Cheol Ho Kim ) 대한내과학회 2007 대한내과학회지 Vol.72 No.1

목적: 노인 환자에서 흔히 관찰되는 빈혈과 노인의 신체적인 기능, 정서적인 기능, 영양상태와의 상관관계를 알아보고 빈혈의 동반 유무가 급성 질환으로 입원한 노인 환자의 예후에 영향을 미치는 가를 알아보고자 본 연구를 수행하였다. 방법: 2004년 5월부터 2005년 4월까지 분당 서울대학교 병원 급성기 노인전문 병동에 입원한 431명의 환자 중 의학적 평가, 기능평가, 영양상태평가, 인지기능평가, 정서상태 평가 등을 포함한 노인 포괄평가가 가능한 환자 308명을 대상으로 입원 당시 혈색소치와 포괄적 노인평가 항목과의 통계적 분석을 시행하였으며 환자의 입원 기간 및 입원 기간 중의 노인 증후군의 발생 빈도를 비교하였다. 결과: 빈혈군이 정상군에 비해 보다 고령이고 남성이 많았으며 영양 결핍과 기능 의존 상태인 특성을 관찰할 수 있었다. 이러한 특성으로 인해 빈혈군에서 입원기간 중 섬망의 발생이 보다 많았고 입원 기간의 유의한 연장이 관찰되었다. 그러나 입원 기간에 영향 미치는 여러 인자 중 빈혈이 독립적인 위험 인자인지를 알아보기 위한 다변량 분석에서 유의한 상관관계는 없었다. 결론: 빈혈은 신체적인 기능, 영양 상태와 밀접한 상관관계가 있으며 전반적인 환자의 상태를 반영해 주는 지표로 생각되나 그 자체가 독립적으로 환자의 입원 기간을 연장시키는 위험인자는 아닐 것으로 생각된다. 향후 노인 환자에서 빈혈의 임상적 의의와 그 치료적 접근에 관해서는 추가적인 임상연구가 수행되어야 할 것으로 생각된다. Background: Anemia is a common medical problem among the elderly; it is more frequent with advancing age. Anemia has been associated with adverse outcomes such as hospitalization, disability and mortality. However, the clinical significance of anemia in frail elderly patients, especially those admitted to acute care units, has not been investigated. Methods: From May 2004 to April 2005, 308 patients 65 years of age or older, admitted to the Acute Elderly Care Unit at the Seoul National University Bundang hospital, were enrolled in the current study. Comprehensive geriatric assessment including medical, psychosocial and functional evaluation was performed by the geriatric team. Clinical and laboratory evaluations were carried out to determine the prevalence and etiology of the anemia. Results: Anemia (Hb < 13 g/dL in male, < 12 g/dL in female) was identified in 149 patients (48.4%). The leading cause of anemia was anemia of chronic disease (N=75, 50.3%). Comparison between the anemic group and a control group was performed. Anemic patients were older, male, had an impaired functional status as well as a poor nutritional status. Moreover, the development of delirium was more frequent in the anemic group compared to the control group (11.0% vs 20.7%, p=0.021). In addition, the duration of hospitalization was significantly increased in patients with anemia (12.97±1.24 vs 18.07±1.77, p=0.019). However, in the multiple regression analysis, the presence of anemia did not affect the length of hospitalization as an independent factor. Conclusions: Anemia is common in frail elderly patients and has been associated with a poor clinical outcome. Although anemia was not an independent risk factor in the elderly patients, the anemia was associated with multiple co-morbidities, disability and frailty. Therefore, the presence of anemia in the elderly requires active investigation and management. (Korean J Med 72:44-51, 2007)

류마티스 관절염 환자에서 빈혈에 대한 임상적 고찰

심승철(Seung Cheol Shim),전재범(Jae Bum Jun),정성수(Sung Soo Jung),이인홍(In Hong Lee),배상철(Sang Cheol Bae),유대현(Dae Hyun Yoo),김성윤(Seong Yoon Kim),정화순(Wha Soon Chung),정낙은(Nak Eun Chung) 대한내과학회 1994 대한내과학회지 Vol.47 No.6

N/A Objectives : Anemia is the most common extra-articular manifestation of rheumatoid arthritis (RA). However neither the frequency of anemia in the patients of RA nor the role of erythroid abnormalities in various types of anemia have been reported previously in Korean population. Methods : To establish the frequency of anemia and the role of erythropoietin in the pathophysiology of anemia, 500 patients with RA were selected randomly from the patients who were diagnosed at Rheumatism center of Hanyang university hospital from January 1993. Results : 1) In the series of 500 RA patients, 196 patients (39.2%) had anemia, and 127 of 196 patients with anemia had mild anemia (Hb more than 10.0 g/dl), the other 69 patients (35%) had moderate to severe anemia. 2) 92 (77.3%) of 120 patients with anemia had anemia of chronic disease (ACD) and iron deficiency anemia (IDA) was observed in 26 patients (22.7%). Other types of anemia were also found: one case had vitamin B12 deficiency anemia, the other case had autoimmune hemolytic anemia. 3) 17 patients with ferritin between 20~100 ng/ml were examined bone marrow aspiration and biopsy. The results of bone marrow biopsy were identical with that of Iron index (=-0.00446×TIBC+1.22765×Log ferritin-0.07824) except one case, 4) ACD had higher value of Ritchie index, ESR, functional class than IDA (p<0.01), Serum iron had no significant differences between ACD and IDA, but TIBC and ferritin had significant differences between two groups (p<0.01). 5) Ritchie index versus Hb (r=-0.38. p<0.01)'and ESR versus Hb (r=-0.53, p<0.01) were negatively related but there were no significant differences in disease duration. 6) Serum erythropoietin was 17.27±1.3 mu/ml in ACD and 35.64±1.7 mu/ml in IDA, and there were significant differences between these two groups (p<0.01). Conclusions : Iron index is a useful method for differential diagnosis between ACD and IDA. In ACD, erythropoietin may be effective in rheumatoid arthritis with moderate to severe anemia.

9개월 영아의 수유방법에 따른 철결핍빈혈에 대한 연구

윤현진,최은정,최은진,홍수영 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.8

Purpose:This study was conducted to evaluate the red cell indices and frequency of iron deficiency anemia based on the feeding patterns of nine-month-old infants. Methods:Blood tests were performed on 253 nine-month-old infants, who visited Il Sin Christian Hospital for health check- ups from January to December 2007. Their parents answered telephonic questions regarding their feeding patterns and weaning foods. Results:Three infants groups were created according to feeding patterns before they started weaning foods. One group was exclusively breast-fed (48.6%), another had mixed feeding (27.3%), and the third had artificial milk feeding (24.1%). Red cell indices (hemoglobin, hematocrit, MCV, MCH) of the breast-fed group were comparatively lower than those of the other two groups (P<0.05). Twenty-five infants (9.9%) were diagnosed with iron-deficiency anemia. According to feeding patterns, the frequency of anemia was highest in the breast-fed group. Six infants who started weaning foods before six months of age (113 infants) were diagnosed with iron-deficiency anemia (5.3%), and nineteen who started after six months of age (140 infants) were diagnosed with iron-deficiency anemia (13.6%). Conclusion:When nine-month old infants visit hospitals for health check-ups, pediatricians must consider their feeding pattern and weaning foods histories, and then recommend screening blood tests for iron-deficiency anemia. (Korean J Pediatr 2008;51:820-826) Purpose:This study was conducted to evaluate the red cell indices and frequency of iron deficiency anemia based on the feeding patterns of nine-month-old infants. Methods:Blood tests were performed on 253 nine-month-old infants, who visited Il Sin Christian Hospital for health check- ups from January to December 2007. Their parents answered telephonic questions regarding their feeding patterns and weaning foods. Results:Three infants groups were created according to feeding patterns before they started weaning foods. One group was exclusively breast-fed (48.6%), another had mixed feeding (27.3%), and the third had artificial milk feeding (24.1%). Red cell indices (hemoglobin, hematocrit, MCV, MCH) of the breast-fed group were comparatively lower than those of the other two groups (P<0.05). Twenty-five infants (9.9%) were diagnosed with iron-deficiency anemia. According to feeding patterns, the frequency of anemia was highest in the breast-fed group. Six infants who started weaning foods before six months of age (113 infants) were diagnosed with iron-deficiency anemia (5.3%), and nineteen who started after six months of age (140 infants) were diagnosed with iron-deficiency anemia (13.6%). Conclusion:When nine-month old infants visit hospitals for health check-ups, pediatricians must consider their feeding pattern and weaning foods histories, and then recommend screening blood tests for iron-deficiency anemia. (Korean J Pediatr 2008;51:820-826)

만성 신부전 환자에서 빈혈 개선에 따른 혈장 수용성 interleukin-2 수용체 농도의 변화

조영일,긴경수,최영숙 건국대학교 1996 學術誌 Vol.40 No.2

To evaluate the effect of anemia on the immune system in chronic renal failure (CRF) patients on hemodialysis (HD), we measured plasma sIL-2R levels in 10 CRF patients with anemia and 10 CRF patients without anemia on HD. In 10 CRF patients with anemia, plasma sIL-2R levels were measured also after correction by transfusion of packed RBCs or subcutaneous injection of rH-EPO. Plasma sIL-2R level was measured using h-IL-2R ELISA kit (Boehringer Manheim Biochemical, Germany) before and after correction of anemia. The results were as follows : Plasma sIL-2R level was 287.36±70.18 pmol/L in uremic patients with anemia and 211.35±49.85 pmol/L in uremic patients without anemia (p<0.05). After correction of anemia, plasma sIL-2R level was 299.55±98.85 pmol/L in "Low-Hct" group (Hct<26%) and 222.61 ±60.05 pmol/L in "High-Hct" group (Hct≥26%) (p<0.05). In anemic patients, plasma sIL-2R level before correction of anemia was 290.50±80.25 pmol/L and after correction of anemia was 243.74± 64.89 pmol/L (p<0.05). On conclusion, plasma sIL-2R level was higher in CRF patients with anemia than CRF patients without anemia. Plasma sIL-2R level in CRF patients with anemia became lowerd after correction of anemia. Key Word : Chronic renal failure, Plasma soluble IL-2 receptor, Anemia, Immune system.

만성 신질환의 중증도와 동반된 빈혈의 빈도에 대한 연구

권정훈 ( Jeong Hun Kwen ),조성 ( Seong Cho ),김성록 ( Sung Rok Kim ) 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.1

목적 : 만성 신질환의 조기 발견 및 치료는 신질환의 진행 억제 ㅣㅊ 심혈관계 합병증 방지를 위해 중요하다. 만성 신질환의 초기부토 동반되는 심한 빈혈을 조혈호르몬 등으로 교정할 수 있는 합병증으로 교정시 심혈관계 합병증을 예발할 수 있으리라 생각된다. 최근 발표된 K/DOQI-CKD Guideline은 신질환의 조기 발견 및 치료를 목표로 하고 있어 국내에서도 이에 대한 연구가 필요하나 현재까지 만성 신질환 정도와 이에 따른 빈혈의 정도, 그리고 빈혈에 영향을 미치는 인자에 대한 연구는 드문 편이다. 이에 본 센타 환자를 대상으로 만성 신질환 정도를 K/DOQI-CKD Guideline에 따라 나누고 이에 따른 빈혈의 빈도 및 정도, 그리고 빈혈에 영향을 미치는 인자를 알아보고자 본 연구를 시작하였다. 방법 : 3개월 이상 안정상태인 만성 신질환 환자를 Abbreviated MDRD Equation으로 계산된 GFR (Glomerular Filtration Rate)에 따라 K/DOQI-CKD Guideline의 5 stage로 분류하였다. 혈역학적 변화를 일으키는 혈색소치인 10.0 g/dL 이하를 빈혈이라 정의하였다. 각 stage에서의 빈혈의 빈도를 조사하였고 빈혈 및 혈색소치에 영향을 미치는 인자를 조사하였다. 결과 : Stage 1, 2, 3, 4, 5의 평균 크레아티닌 치는 각각 0.87±0.15 (0.7-1.1) mg/dL;1.04±0.18 (0.8-1.4) mg/dL; 1.69±0.36 (1.1-2.7) mg/dL; 2.90±0.66 (1.9-4.7) mg/dL; 5.01±1.28 (3.3-8.8) mg/dL이었다. 각 군의 평균 혈색소 및 빈혈의 빈도는 stage 1, 2, 3, 4, 5에서 각각 12.95±1.46 (10.5-15.4) g/dL, 0%; 13.31±2.20 (7.8-17.7) g/dL, 10.3%; 11.32±2.07 (7.4-16.6) g/dL, 25.5%; 10.10±1.71 (6.7-14.0) g/dL, 54.8%; 9.21±1.53 (6.2-12.2)g/dL, 76.9%이었다. Stage 3, 4, 5에서 당뇨군과 비당뇨군의 빈혈의 빈도는 가각 36.7 vs 12.0% (p=0.06); 70.6 vs 35.7% (p=0.000); 100 vs 64.7% (p=0.06)로 당뇨군이 높았다. 빈혈의 빈도에 영향을 미치는 독립적 인자로는 신기능에 따른 stage외에 원인질환이 당뇨별 (OR 2.53, p=0.033 compared with non-diabetes mellitys), 저알부민치 (OR 5.38, p=0.001 for 3.0-1.4 compared with 4.0-5.3 g/dL)로 나타났다. GFR, 성별, 당뇨병인 경우, 알부민치가 혈색소치와 독립적으로 유의한 관계가 있는 것으로 분석되었다 (R^2=0.571, p<0.001). 결론 : 만성신부전 환자의 빈혈은 신부전 초기인 stage 3에서 상당수 (25.5%) 발생하였고 stage 4, 5에서는 각각 54.8%, 76,9%로 신부전이 심해질수록 증가하였다. 원인 질환이 당뇨병인 경우, 심한 저알부민혈증 (3.0-1.4 g/dL)일 경우 빈혈의 빈도가 증가하였다. Background : Early detection and treatment of chronic kidney disease (CKD) are important for inhibition of kidney disease progression and prevention of cardiovascular complications. Treatment of Anemia that is frequently accompanied with CKD, are important for prevention of cardiovascular complications. The lastest K/SOQI-CKD guideline targets early detection and treatment of kidney disease, and the study for these are necessary in Korea. In Korea, until mowadays, the study for prevalence, severity of anemia and influencing factors on anemia in CKD, were rare. Thus in our center, we classified patient for severity of CKD as K/DOQI-CKD guideline and studied prevalence, severity of anemia and influencing factors on anemia. Methods : According to K/DOQI-CKD guideline, patients were staged by GFR calculated by Adbbreviated MDRD Study Equation. Anemia was defined by Hb lessl than 10.0 g/dL below which hemodynamic change develops. We examined the frequency of anemia and independent factors that influences on anemia in study patients. Results : Mean creatinine levels for stage 1 to 5 were 0.87±0.15 (0.7-1.1) mg/dL; 1.04±0.18 (0.8-1.4) mg/dL; 1.69±0.36 (1.1-2.7) mg/dL; 2.90±0.66 (1.9-4.7) mg/dL; 5.01±1.28 (3.3-8.8) mg/dL. Mean Hb levels and percentage of anemic patients in each stages were 12.95±1.46 (10.5-15.4) g/dL, 0%; 13.31±2.20 (7.8-17.7) g/dL, 10.3%; 11.32±2.07 (7.4-16.6) g/dL, 25.5%; 10.10±1.71 (6.7-14.0) g/dL, 54.8%; 9.21±1.53 (6.2-12.2) g/dL, 76.9%. The frequency of anemia were high in Diabeltes Mellitus Mellitus (DM) compared to Non-Diabeltes (Non-DM) at stage 3, 4, 5 [36.7 vs 12.0% (p=0.06); 70.6 vs 35.7% (p=0.000); 100 vs 64.7% (p=0.06)]. Multivariate logistic regression analysis revealed that DM as etiology (OR 2.53, p=0.033 compared with Non-DM), Albumin level (OR of 5.38 p=0.001 for 3.0-1.4 compared with 4.0-5.3 g/dL) were independent factor determing anemia state in addition to K/DOQI guideline stage. GFR, sex, DM, Albumin level were independent factors associated with hemoglobin levels (R^2=0.571, p<0.001). Conclusion : Anemia in CKD was developed relatively early and frequently at stage 3 (Cr, 1.69±0.36 mg/dL, 25.5%) and more aggravated as decreasing renal function (stage 4, 5; 54.8%, 76.9%). DM as underlying disease, hypoalbuminemia were, independently influenced Anemia development.