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Mean Corpuscular Volume

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41. Iron Deficiency – Diagnosis and Management

are highly suggestive of iron deficiency: hypochromia (low mean corpuscular hemoglobin concentration (MCHC)) microcytosis (low mean corpuscular volume (MCV)) Patients with microcytic anemia should not be given iron supplements until iron deficiency is confirmed by testing ferritin. Low MCV in the setting of normal ferritin may indicate hemoglobinopathies such as thalassemia especially in high risk ethnic groups. Long term iron therapy is harmful for these patients. Refer to . Additional tests (...) at First Nations Health Authority Guide to Your Baby’s First Solid Foods: Traditional Foods Fact Sheets: List of Abbreviations ACD CBC Fe GI GU ID IDA IM IV MCHC MCV TSAT anemia of chronic disease complete blood count iron gastrointestinal genitourinary iron deficiency iron deficiency anemia intramuscular intravenous mean corpuscular hemoglobin concentration mean corpuscular volume transferrin saturation This guideline is based on scientific evidence current as of January 2019. The guideline

2019 Clinical Practice Guidelines and Protocols in British Columbia

42. Oral vitamin B<sub>12</sub> versus intramuscular vitamin B<sub>12</sub> for vitamin B<sub>12</sub> deficiency. (PubMed)

by Cochrane. Our primary outcomes were serum vitamin B12 levels, clinical signs and symptoms of vitamin B12 deficiency, and adverse events. Secondary outcomes were health-related quality of life, acceptability to patients, haemoglobin and mean corpuscular volume, total homocysteine and serum methylmalonic acid levels, and socioeconomic effects. We used GRADE to assess the quality of the evidence for important outcomes. We did not perform meta-analyses due to the small number of included trials (...) and substantial clinical heterogeneity.Three RCTs met our inclusion criteria. The trials randomised 153 participants (74 participants to oral vitamin B12 and 79 participants to IM vitamin B12). Treatment duration and follow-up ranged between three and four months. The mean age of participants ranged from 38.6 to 72 years. The treatment frequency and daily dose of vitamin B12 in the oral and IM groups varied among trials. Only one trial had low or unclear risk of bias across all domains and outcome measures

2018 Cochrane

43. Assessment of anaemia

of macrocytic anaemia in which DNA synthesis is normal. Megaloblasts and hypersegmented neutrophils are absent. [Figure caption and citation for the preceding image starts]: Megaloblastic macrocytic anaemia From the collection of Dr Robert Zaiden; used with permission [Citation ends]. [Figure caption and citation for the preceding image starts]: Classification of anaemia: MCV, mean corpuscular volume; fL, femtolitres Created by the BMJ Knowledge Centre [Citation ends]. Differentials Trauma Acute (...) into the circulation. After one further day in the circulation, reticulocytes lose their ribosomal network and become mature RBCs, which circulate for 110-120 days before being removed from the circulation by macrophages. At steady state, the rate of RBC production equals the rate of RBC loss. Anaemia develops when the rate of RBC production decreases and/or the rate of RBC loss increases. Morphological classification of anaemia The most clinically useful classification system is based on the mean corpuscular

2018 BMJ Best Practice

44. Polycythaemia vera

History and exam presence of risk factors features of thrombosis features of haemorrhage asymptomatic headache generalised weakness/fatigue pruritus erythromelalgia redness of fingers, palms, toes, heels facial redness splenomegaly affected family member age >40 years Budd-Chiari syndrome (BCS) Diagnostic investigations haemoglobin haematocrit white blood cell (WBC) count platelet count mean corpuscular volume (MCV) liver function tests (LFTs) JAK2 gene mutation screen oxygen saturation haemoglobin

2018 BMJ Best Practice

45. Assessment of anaemia

of macrocytic anaemia in which DNA synthesis is normal. Megaloblasts and hypersegmented neutrophils are absent. [Figure caption and citation for the preceding image starts]: Megaloblastic macrocytic anaemia From the collection of Dr Robert Zaiden; used with permission [Citation ends]. [Figure caption and citation for the preceding image starts]: Classification of anaemia: MCV, mean corpuscular volume; fL, femtolitres Created by the BMJ Knowledge Centre [Citation ends]. Differentials Trauma Acute (...) into the circulation. After one further day in the circulation, reticulocytes lose their ribosomal network and become mature RBCs, which circulate for 110-120 days before being removed from the circulation by macrophages. At steady state, the rate of RBC production equals the rate of RBC loss. Anaemia develops when the rate of RBC production decreases and/or the rate of RBC loss increases. Morphological classification of anaemia The most clinically useful classification system is based on the mean corpuscular

2018 BMJ Best Practice

46. HTA of C-reactive protein point-of-care testing to guide antibiotic prescribing

. As the included semi-quantitative devices have an upper limit of 80mg/L, they may be of limited use in terms of current guidelines for antibiotic prescribing that use a cut-point of =100 mg/L for antibiotic prescribing. The majority of the evidence suggested acceptable performance for all 11 quantitative devices in the laboratory setting. Most of the devices had a mean difference of 80 mg/L for strips and high of =20 mg/L for single-use disposable device. One device co-tests for the viral biomarker MxA (...) devices sold into the Irish market comply with the relevant legislation. This means that a medical device must achieve the performance criteria specified by the manufacturer and in doing so must not compromise the health and safety of patients, service providers and any other persons. In its role as the Competent Authority, the HPRA operates a vigilance system for medical devices. Vigilance issues include adverse incidents and field safety corrective actions (FSCAs). An adverse incident is an event

2019 Health Information and Quality Authority

47. The Collaborative Assessment, OTCA12, on “C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescribing in primary care settings for acute respiratory tract infections (RTIs)

pharyngitis (Centor Score 1-4: sensitivity: 0.90; specificity 0.45), but only if RADT is not available (Centor Score 1-4: sensitivity: 0.90; specificity 0.97) [6]. The low specificity of this cut-point means that many false positives may be treated unnecessarily with antibiotics. (D1005, D1006) Nine studies reported on the usefulness of CRP in LRTI and, or specifically in pneumonia. Five studies reported on the diagnostic accuracy of CRP at a specified threshold for diagnosing pneu- monia. Four studies (...) of accuracy for CRP POCT are a bias (the difference between the measured value and the true value) that is no greater than 15% (10% for some health bodies). The most common methods of reporting accuracy were agreement from a Passing Bablok regression, correlation from a Pearson or Spearman correlation coefficient or a mean difference from Bland-Altman plots. Precision is a measure of the random error in an assay and can presented as a coefficient of vari- ation (CV); Scandinavian health bodies and other

2019 EUnetHTA

48. Iron-ing Out the Wrinkles in Anemia Management

be supported. Evidence: • Randomized controlled trials. Differences statistically significant unless indicated. o General population adults: ? 80 patients (92% female, mean age 39): 1 iron polysaccharide (Niferex™) versus ferrous fumarate, both ~150mg/day elemental iron. After 12 weeks: • Ferrous fumarate improved hemoglobin (28.4g/L) more than iron polysaccharide (6g/L). o Ferrous fumarate: Better serum ferritin, mean corpuscular volume, and transferrin saturation but more nausea (31% versus 3%). ? 43 (...) patients: 2 iron polysaccharide (Niferex™) versus ferrous fumarate - similar hemoglobin improvements after ~4 weeks. o Children: ? 80 children (mean age 23 months): 3 Iron polysaccharide (NovaFerrum™) versus ferrous sulfate, both 3mg/kg/day elemental iron. • At 12 weeks, ferrous sulphate improved hemoglobin more (10g/L), resolved IDA (29% vs 6%, Number Needed to Treat=5), caused less diarrhea (35% versus 58%). ? 32 premature infants: 4 Iron polysaccharide versus ferrous sulphate (both 7.5mg/day

2019 Tools for Practice

49. Iron Deficiency and Anaemia in Adults

disease IDA iron deficiency MCH mean cell haemoglobin MCHC mean corpuscular haemoglobin concentration MCV mean cell volume PBM patient blood management PPH primary postpartum haemorrhage PRCA pure red-cell aplasia QoL quality of life RBC red blood cells TSAT transferrin saturation Acronyms and abbreviationsROYAL COLLEGE OF NURSING 41IRON DEFICIENCY AND ANAEMIA IN ADULTS: RCN GUIDANCE FOR NURSING PRACTICE 42ROYAL COLLEGE OF NURSING 4344 The RCN represents nurses and nursing, promotes excellence (...) . Iron deficiency results in a failure to synthesise haemoglobin. In cases of hypochromia the MCH (mean cell haemoglobin) is reduced as there is less haemoglobin within the red blood cells. This makes the cells appear pale. The lack of haemoglobin also makes the cells smaller than they should be, leading to a reduced MCV (mean cell volume). Causes of absolute iron deficiency (AID) Inadequate dietary intake Poor nutrition. Chronic alcoholism. Vegetarianism (decreased consumption of animal protein

2018 Royal College of Nursing

50. Alpha-thalassaemia

Diagnostic investigations haemoglobin (Hb) mean corpuscular volume (MCV) mean corpuscular haemoglobin (MCH) RBC count peripheral smear reticulocyte percentage serum iron serum ferritin brilliant cresyl blue staining of red blood cells haemoglobin electrophoresis Hb fractionation by high-performance liquid chromatography (HPLC) gap-PCR multiplex ligation-dependent probe amplification (MLPA) direct sequencing MRI (hepatic or cardiac) superconducting quantum interference devices (SQUID) liver biopsy

2017 BMJ Best Practice

52. Alcoholic Liver Disease

inaccurate, the use of alcohol biomarkers can be useful to diagnose alcohol consump- tion. Of the biochemical tests, mean corpuscular volume, ami- notransferases, and ? -glutamyl transferase are sensitive tests, but lack specifi city in patients with cirrhosis ( 34 ). Carbohydrate- defi cient transferrin combined with ? -glutamyl transferase has sensitivity of about 75–90%. However, the levels of carbohydrate- defi cient transferrin may be confounded with increasing dis- ease severity and active smoking (...) damage (Mallory–Denk bodies and/or ballooning), bilirubin sta- sis and liver fi brosis, which is typically described as peri cellular and sinusoidal (“chicken wire” appearance) ( 58 ) ( Figure 4 ). Th ese features are indistinguishable from non-ASH and the alcohol– non-ALD index (including body mass index, gender, AST, ALT, and mean cell volume of the red blood cells or mean corpuscular volume) can be helpful to distinguish the two in cases of unclear alcohol consumption ( 59 ). Th e majority of AH

2018 American College of Gastroenterology

53. Pharmacological Treatment of Patients with Alcohol Use Disorder

corpuscular volume MDD Major depressive disorder MET Motivational enhancement therapy MI Motivational interviewing MM Medical management NIAAA National Institute on Alcohol Abuse and Alcoholism NIMH National Institute of Mental Health NNT Number needed to treat NQF National Quality Forum OPRM1 Genotype Opioid receptor µ 1 genotype OR Odds ratio OTC Over-The-Counter PCM Primary Care Management PEth Phosphatidylethanol Project MATCH Matching Alcoholism Treatments to Client Heterogeneity PTSD Posttraumatic (...) Edition, Text Revision DSM-5 Diagnostic and Statistical Manual of Mental Disorders, 5th Edition eGF Estimated glomerular filtration rate FDA U.S. Food and Drug Administration GGT Gamma-glutamyl transferase GRADE Grading of Recommendations Assess- ment, Development and Evaluation GWG Guideline Writing Group HIV Human immunodeficiency virus ICD-10 International Classification of Diseases, 10th Revision IM Intramuscular IRR Incidence rate ratio MBSCT Modified behavioral self-control therapy MCV Mean

2017 American Psychiatric Association

54. Carrier Screening for Genetic Conditions

(African, Mediterranean, Middle Eastern, Southeast Asian, or West Indian descent). If red blood cell indices indicate a low mean corpuscular hemoglobin or mean corpuscular volume, hemoglobin electrophoresis also should be performed. Fragile X premutation carrier screening is recommended for women with a family history of fragile X-related disorders or intellectual disability suggestive of fragile X syndrome and who are considering pregnancy or are currently pregnant. If a woman has unexplained ovarian (...) to counsel couples who are carriers of one of the thalassemias or sickle cell disease. To ensure accurate hemoglobin identification, which is essential for genetic counseling, a complete blood count with red blood cell indices should be performed in all women who are currently pregnant to assess not only their risk of anemia but also to allow assessment for risk of a hemoglobinopathy. If red blood cell indices indicate a low mean corpuscular hemoglobin or mean corpuscular volume, hemoglobin

2017 American College of Obstetricians and Gynecologists

56. British Association of Dermatologists' guidelines for the safe and effective prescribing of methotrexate for skin disease

discussing with gastroenterologist New or increasing dyspnoea or dry cough Withhold/decrease dose of MTX; repeat chest X-ray and pulmonary function tests and discuss with respiratory team Severe sore throat, abnormal bruising Withhold MTX; check FBC immediately WBC, white blood cells; MTX, methotrexate; MCV, mean corpuscular volume; AST, aspartate aminotransferase; ALT, alanine transaminase; LFT, liver function test; FBC, full blood count. © 2016 British Association of Dermatologists British Journal (...) a clinically signi?cant difference between the two groups. In an open-label study of 60 patients with a very diverse range of eczematous disorders, a 68% mean reduction in Eczema Area and Severity Index score was reported in those given MTX in doses of up to 75 mg weekly (n = 30) com- pared with a 21% reduction in those given just folic acid 5 mg daily (n = 30). 15 In this study, 40% of patients had ato- pic eczema, 31% had contact dermatitis, 12% had pompholyx, 8% had seborrhoeic dermatitis, 5% had lichen

2016 British Association of Dermatologists

57. Endoscopic screening using esophageal iodine staining and genotypes of ADH1B and ALDH2 in Japanese alcohol-dependent women. (PubMed)

observed according to ADH1B and ALDH2 genotypes. Multiple logistic regression analyses showed that the slow-metabolizing ADH1B*1/*1 genotype (odds ratio [95% confidence interval], 12.5 [4.82-32.4] and 9.89 [3.50-27.9]), the inactive heterozygous ALDH2*1/*2 genotype (2.94 [1.18-7.38] and 3.79 [1.40-10.3]), a lower body mass index per -1 kg/m2 (1.17 [1.02-1.35] and 1.38 [1.14-1.67]), and a mean corpuscular volume ≥106 fl (3.70 [1.56-8.81] and 3.27 [1.24-8.64]) increased the risk of DIULs ≥5 mm

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2019 PLoS ONE

58. Beneficial Effects of ragi (Finger Millet) on Hematological Parameters, Body Mass Index, and Scholastic Performance among Anemic Adolescent High-School Girls (AHSG). (PubMed)

hemoglobin, mean corpuscular hemoglobin concentration, mean corpuscular volume, red cell distribution width, body mass index, and scholastic performance. The data show that daily dietary supplementation with ragi porridge has a positive effect on hemoglobin levels in adolescent high schools girls. A well planned nutrition education with dietary supplementation is thus recommended for better outcomes. (...) porridge on hematological parameters was evaluated on the intervention group at 45 and 90 days. Both groups were monitored for changes in body mass index and scholastic performance. A statistically significant increase in hemoglobin levels was observed in the intervention group after 90 days (from a mean of 11.3 g% to 12.54 g%; t (29) = 7.514, p < .0001), with no significant changes in the control group. No statistically significant differences between the two groups were observed for mean corpuscular

2018 Comprehensive child and adolescent nursing

59. Low fetal hemoglobin percentage is associated with silent brain lesions in adults with homozygous sickle cell disease (PubMed)

sickle cell referral center for which steady-state measurements of biological parameters and magnetic resonance imaging scans of the brain were available. WMCs were rated by consensus, on a validated age-related WMC scale. The prevalence of WMCs was 49% (95% confidence interval [CI], 39%-60%) in the 83 patients without vasculopathy included. In univariable analysis, the patients who had WMCs were more likely to be older (P = .003) and to have hypertension (P = .02), a lower mean corpuscular volume (P (...) = .005), a lower corpuscular hemoglobin concentration (P = .008), and a lower fetal hemoglobin percentage (%HbF) (P = .003). In multivariable analysis, only a lower %HbF remained associated with the presence of WMCs (odds ratio [OR] per 1% increase in %HbF, 0.84; 95% CI, 0.72-0.97; P = .021). %HbF was also associated with WMC burden (P for trend = .007). Multivariable ordinal logistic regression showed an inverse relationship between WMC burden (age-related WMC score divided into 4 strata) and HbF

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2017 Blood advances

60. Red blood cell distribution width and ischaemic stroke (PubMed)

Red blood cell distribution width and ischaemic stroke The red blood cell distribution width (RDW) is a measure of red blood cell (RBC) size heterogeneity, which is easily calculated by dividing the SD of erythrocyte volumes for the mean corpuscular volume. Recent reporter suggested that, besides haematological diseases and anaemia, many human disorders may be closely associated with the elevated RDW. A literature review has revealed the RDW may be closely related to the development

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2017 Stroke and vascular neurology

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