The relationship between hemoglobin concentration and all-cause mortality in acute ischemic stroke (AIS) patients remains unclear due to conflicting findings. This study aims to evaluate the impact of hemoglobin concentration on the risk of both short-term and long-term all-cause mortality in AIS patients from a nationwide stroke registry. We utilized data from the Singapore Stroke Registry (SSR), including patients >18years old at first AIS onset, and received treatment at a local hospital between 2005 and 2020. Patients were stratified according to sex-specific hemoglobin concentration cut-offs on anemia severity and polycythemia from the World Health Organization. Multivariate logistic regression and Cox proportional hazards modeling were performed, adjusting for demographics and cardiovascular risk factors. A total of 56,884 ischemic stroke patients were included, of which 66.8% had no anemia, 15.7% had mild anemia, 12.2% had severe anemia, and 5.3% had polycythemia. The cohort was predominantly male (57%), with a median age of 68 years. The median follow-up duration was 10-years (IQR 7-13). Compared to patients with normal-range hemoglobin, both mild and severe anemia was associated with elevated short-term and long-term risks of all-cause mortality. Severe anemia was associated with the highest risk of all-cause mortality, with hazard ratios of 1.99 (95%CI:1.92-2.06) at 30-days, 1.73 (95%CI:1.66-1.81) at 1-year, and 1.52 (95%CI:1.41-1.64) at 5-years. However, the excess risk associated with severe anemia appeared to attenuate at 10-years, whilst the elevated risk persisted among patients with mild anemia. In this nationwide stroke registry, anemia is prevalent among AIS patients and is significantly associated with both short-term and long-term mortality.
Chronic kidney disease progression is influenced by anemia and comorbidities; however, the possibility of a real effect of these two phenomena has hardly been the subject of research. The present study set out to evaluate the association between anemia and burden of comorbidities on CKD progression and hospitalizations over 1 year. A retrospective study involving 120 adult CKD patients. Anemia was defined as hemoglobin < 13 g/dL in males and < 12 g/dL in females while comorbidity burden was defined by a simple comorbidity index: hypertension, diabetes, and cardiovascular disease. CKD progression was coded as a ≥ 25% decline in eGFR or stage conversion. Multivariate logistic regression identified predictors of hospitalization. Participants' mean age was 58.3 years, and 53.3% were males. Anemia was present in 67.5% of the cases, and 33.3% had two or more comorbidities. CKD progression was seen in 43.3% at 1 year; patients with anemia and two or more comorbidities showed the highest progression rate at 77.5% (p < 0.001). Progressors had significantly lower hemoglobin and higher RDW values. Hospitalization was documented in 29.2%, and anemia independently predicted hospitalization (OR 3.4); comorbidity index ≥ 2 (OR 2.8), and RDW > 14.5% (OR 2.6). Each 1 g/dL increase in hemoglobin reduced hospitalization risk by 28% (OR 0.72). Anemia and multiple comorbidities jointly increased the risk of CKD progression and hospitalization. Routine hematological parameters along with assessing comorbidities might have a role to play in early risk stratification and guiding focused interventions in CKD management.
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disorder characterized by complement-mediated hemolysis, thrombosis, bone marrow failure, and anemia. Although current treatments improve outcomes, patients still experience hemolysis and could remain anemic with a negative impact on quality of life (QoL). The aim of this study was to assess whether patient-reported outcomes (PROs) distinguish PNH patients with/without hemolysis and evaluate factors associated with PROs. In this international, multicenter, observational study, 97 PNH patients witfrom Italy and the UK completed the EORTC QLQ-C30 and QLQ-AA/PNH measures at baseline and after 2 weeks. Clinical, biochemical, and treatment data were collected. Hemolysis was defined as LDH ≥ 1.5 × upper normal limit. PRO scores were compared between patients above and below this threshold. Associations of PROs with patient and disease factors were analyzed. Of 97 patients (mean age 49 ± 15), 24.7% were anemic (Hb < 10 g/dL) and 16% had hemolysis. QoL did not differ significantly by hemolysis status. However, anemia was associated with significantly lower EORTC QLQ-C30 global health and functional scores (p < 0.05), particularly in physical, role, and social domains, and with worse QLQ-AA/PNH emotional, cognitive, and physical functioning, as well as greater illness intrusiveness and stigmatization. Fatigue, dyspnea, and pain were common symptoms in anemic patients. QLQ-AA/PNH scores showed high internal consistency (Cronbach's α > 0.7) and test-retest reliability (ICC: 0.72-0.95). Anemia, but not residual hemolysis, was associated with impaired QoL across multiple domains. Addressing anemia alongside hemolysis may improve PROs in the management of PNH. The authors have confirmed clinical trial registration is not needed for this submission.
Anemia is a common condition in older adults and is associated with increased morbidity, geriatric syndromes, and functional decline. We report the case of an 86-year-old woman who presented with severe anemia accompanied by neurologic, hematologic, and oral manifestations, in whom vitamin B12 deficiency was identified as the underlying etiology. Following targeted parenteral cyanocobalamin therapy, the patient demonstrated marked hematologic recovery and substantial improvement in gait, strength, and independence in basic activities of daily living, as documented through a comprehensive geriatric assessment. This case underscores the importance of recognizing vitamin B12 deficiency as an underdiagnosed yet reversible cause of anemia and functional deterioration in older adults and highlights the essential role of comprehensive geriatric assessment in detecting reversible contributors to frailty and enabling timely, individualized intervention.
Diamond-Blackfan anemia (DBA) is an inherited anemia characterized by ribosome defects that reduce globin chain production, producing an excess of toxic heme. Bitopertin selectively reduces heme synthesis, rebalances globin-heme production, and improves anemia in model systems. We report the first clinical trial of bitopertin for the treatment of steroid-relapsed/refractory DBA. This was an open-label, intrapatient dose-escalation study in 15 heavily pretreated, transfusion-dependent adult DBA patients (ClinicalTrials.gov NCT05828108). Bitopertin dosing increased monthly (5 mg escalating to 60 mg, daily), followed by 3-months maintenance. Primary endpoint was response (hemoglobin level, erythrocyte transfusions). Secondary endpoints were safety (adverse events, AE) and tolerability. Twelve patients completed the full 8-month course (2 discontinued early for non-bitopertin-related serious AE (SAE), 1 lost-to-follow-up). All 12 patients reached the planned 60-mg maximum dose. Two de-escalated to 40 mg (1 grade-2 dizziness, 1 concern for loss of early effect). Seven SAEs were reported, all unlikely/unrelated to bitopertin. Plasma drug levels were consistent with prior studies. At 10 mg daily and greater, all patients reached levels consistent with EC50. There was a time-dependent/dose-dependent reduction of reticulocyte hemoglobin content. There were no clinical responses. Bitopertin is safe, bioavailable, and well-tolerated in steroid-refractory DBA. Although bitopertin did not result in transfusion-independence, iron overload, marrow hypocellularity and prior steroid failure reflect a cohort with long-standing disease and minimal hematopoietic marrow reserve. Additionally, based on model systems, dosing may have escalated too rapidly, missing a potential lower effective dose. Future studies will test slower dose escalation of bitopertin as a steroid-sparing agent for steroid-responsive DBA patients.
Anemia in chronic kidney disease (CKD) is associated with increased cardiovascular risk, impaired quality of life, and reduced survival. Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), has demonstrated non-inferior efficacy to erythropoiesis-stimulating agents (ESAs) for anemia correction in CKD. Gut microbiota modulate the intestinal HIF-iron metabolism axis, thereby regulating intestinal iron absorption. This cross-sectional study investigated the association between gut microbiome composition and iron-metabolism response to roxadustat, and developed a logistic regression model to identify factors associated with iron metabolism non-response in anemic patients undergoing peritoneal dialysis (PD). Demographic and clinical data were collected at study enrollment, and fecal samples underwent 16S rRNA gene sequencing. Microbial taxa associated with the iron-metabolism response to roxadustat were identified using linear discriminant analysis effect size (LEfSe), differential abundance analysis with DESeq2, and Spearman's rank correlation analysis. Key microbial features were further selected using random forest analysis. Multivariable logistic regression models were constructed using R software (version 4.2.3). Variable selection was performed through stepwise selection based on the Akaike information criterion. Model performance was evaluated with the area under the receiver operating characteristic curve, calibration curves, and decision curve analysis. Internal validation was performed using 10-fold cross-validation and bootstrapping with 1,000 iterations. The overall iron-metabolism response rate to roxadustat was 39% among the enrolled participants. Random forest analysis identified microbial features associated with the iron-metabolism response to roxadustat. The final multivariable model included Clostridium perfringens, Propionibacterium acnes, Bacilli, Paraeggerthella hongkongensis, compound α-ketoacid tablets, and antihypertensive medication. The final model achieved an AUC exceeding 0.8, with favorable calibration and clinical utility, and showed good discriminative performance for iron metabolism non-response to roxadustat in PD patients. Distinct gut microbiome signatures are associated with the iron metabolism response to roxadustat in anemic PD patients.
Gastric lipomas are rare, benign mesenchymal tumors composed of mature adipose tissue, accounting for less than 3% of all benign gastric neoplasms. They are typically asymptomatic but can occasionally present with gastrointestinal bleeding or obstruction when large. Due to their submucosal origin and nonspecific clinical features, preoperative diagnosis can be challenging. A 71-year-old male presented with fatigue, melena, and hypotension. Laboratory tests revealed iron deficiency anemia (hemoglobin 7.9 g/dL) and thrombocytopenia. Upper GI endoscopy showed a submucosal lesion of size 4 × 5 cm in the distal gastric body with a central depression and visible vessel, suggestive of GIST, but a biopsy was not performed due to the submucosal location and high suspicion of a mesenchymal tumor. CT confirmed a well-circumscribed submucosal mass. The patient underwent distal gastrectomy with gastrojejunostomy. Histopathology revealed a submucosal lipoma with tumor-free margins. Although gastric lipomas are usually asymptomatic, larger lesions can lead to mucosal ulceration and bleeding. In such cases, surgical resection remains the treatment of choice, providing both diagnostic confirmation and complete cure. Awareness of this rare cause of upper GI bleeding can help prevent misdiagnosis as malignant tumors, such as GIST. Gastric lipoma, while rare, should be considered in elderly patients presenting with unexplained GI bleeding or anemia. Complete surgical excision offers an excellent prognosis.
Childhood anemia remains a major public health challenge in Sub-Saharan Africa, adversely affecting physical growth, cognitive development, and child survival. The pooled prevalence across 26 countries exceeds 60%, underscoring the need for accurate and scalable prediction tools to support targeted interventions.This study used pooled Demographic and Health Survey (DHS) data (2016-2024) from 26 Sub-Saharan African countries, including 110,251 children aged 6-59 months. Multiple machine learning models (Logistic Regression, Decision Tree, Extra Trees, Random Forest, XGBoost, LightGBM, CatBoost, and MLP) were trained using hyperparameter tuning with 5-fold cross-validation. Model performance was evaluated using accuracy, precision, recall, F1-score, and ROC-AUC, with 95% confidence intervals estimated via bootstrapping. Model comparisons were conducted using the DeLong test, and SHAP was used for model interpretability.The CatBoost model demonstrated the best overall performance (ROC-AUC = 0.84, 95% CI: 0.840-0.848), followed closely by XGBoost and LightGBM. All machine learning models significantly outperformed logistic regression (p < 0.001, DeLong test), although the absolute improvement in discrimination was modest (ΔAUC ≈ 0.04). The models demonstrated moderate discriminatory ability, with relatively low to moderate sensitivity (recall ≈ 0.33-0.41) depending on the model and classification threshold. SHAP analysis identified residence type, height-for-age z-score, country, and child age as the most influential predictors.Machine learning models demonstrated moderate to strong discriminatory performance in predicting childhood anemia using DHS data. Although improvements over traditional models were statistically significant, the relatively low sensitivity limits their effectiveness as standalone screening tools. These findings highlight the importance of early childhood nutrition (particularly during 6-23 months), reduction of chronic undernutrition, and context-specific public health strategies. Integration of predictive analytics into national health systems may support risk stratification and resource allocation in high-burden settings. However, findings should be interpreted in light of the cross-sectional design and lack of external validation.
Iron deficiency anemia (IDA) is common among women of reproductive age and is frequently associated with abnormal uterine bleeding (AUB). Although oral iron is first-line therapy, the optimal dosing schedule remains uncertain. This study compared daily and alternate-day oral iron in real-world practice. We conducted a prospective observational cohort study of women aged 18-70 years with confirmed IDA treated with oral ferrous sulfate at a tertiary referral center between January 2023 and June 2024. Patients received oral iron every 24 h or every 48 h according to physician prescription. AUB etiology was classified using the PALM-COEIN system. Outcomes included hemoglobin change, World Health Organization anemia severity, hemoglobin normalization (≥12 g/dL), adherence, adverse-event-related discontinuation, and intravenous iron escalation. A total of 171 women were included. Leiomyomas were the most frequent PALM-COEIN category (106 patients, 62.0%). Mean baseline hemoglobin was 9.02 ± 1.45 g/dL. At 6 weeks, mean hemoglobin was 10.91 ± 1.76 g/dL in the 24-h group and 11.26 ± 1.86 g/dL in the 48-h group (p = 0.255). At 3 months, final hemoglobin was available in 147 patients; mean values were 12.79 ± 1.68 g/dL and 12.68 ± 1.62 g/dL, respectively (p = 0.692). Hemoglobin normalization occurred in 75.2 and 71.7% of patients, respectively (p = 0.687). Adherence was high, and discontinuation due to adverse events was uncommon. Intravenous iron escalation was numerically more frequent with alternate-day therapy (26.8% vs. 13.9%; p = 0.056), although escalation decisions were based on clinical judgment without standardized criteria. Both regimens were associated with hematologic improvement. However, because allocation was non-randomized, baseline differences were present, and intravenous iron escalation was not based on standardized criteria, equivalence cannot be inferred. Oral iron dosing should be individualized.
To characterize clot waveform analysis (CWA) parameters (delta and derivative values), alongside standard coagulation parameters (prothrombin time [PT], activated partial thromboplastin time [aPTT], and fibrinogen) in dogs diagnosed with immune-mediated hemolytic anemia (IMHA) using a turbidimetric optical clot detection-based analyzer. Retrospective study from January 2018 to October 2022. University teaching hospital. Thirty-five client-owned dogs diagnosed with IMHA. CWA parameters were characterized by an increased PT delta in 35 of 35 dogs with IMHA (100%) and an increased PT first derivative, aPTT delta, and aPTT second derivative in 34 of 35 (97.1%). Compared with healthy controls, the PT was prolonged and the fibrinogen concentration was increased in most of the IMHA cohort, while the aPTT fell within the reference interval. Of the 18 patients that had D-dimers performed, 17 (94.4%) measured above the reference interval. CWA of patients with IMHA revealed increased parameters compared with the reference intervals, consistent with a hypercoagulable state. This measurement may be helpful in identifying patients that may benefit from antithrombotic therapy.
Crohn's colitis may rarely present with severe bleeding and tumor-mimicking colonic lesions, creating concern for malignancy. A 20-year-old bedridden man with cerebral palsy had recurrent hematochezia and transfusion-dependent microcytic anemia, with hemoglobin 2.8 g/dL. Colonoscopy showed diffuse raised island-like plaques with vascular-pattern loss, rectal sparing, edematous ileocecal valve, and an oozing transverse-colon lesion requiring clipping. Multisite biopsies showed chronic active colitis with crypt distortion, cryptitis, and crypt abscesses, without granulomas, dysplasia, or malignancy. Tissue tuberculosis polymerase chain reaction was negative; interferon-gamma release assay was unavailable. Crohn's colitis was favored by clinicopathologic correlation. Bleeding resolved after corticosteroids, infliximab, and azathioprine; hemoglobin improved to 9.9 g/dL.
To evaluate transfusion practices and short-term hematologic recovery in adolescents presenting with heavy menstrual bleeding (HMB) and hemoglobin levels <10 g/dL, with particular focus on changes in hemoglobin and iron stores during follow-up. This retrospective cohort study included adolescents aged 10-19 years who presented with HMB and anemia (hemoglobin <10 g/dL) at a tertiary referral center between January 2020 and January 2023. Follow-up clinical and hematologic data were analyzed when available. Clinical characteristics, laboratory findings, treatments, transfusion practices, and follow-up data were obtained from medical records. Changes in hemoglobin (ΔHb) and ferritin (ΔFerritin) were assessed. Multivariate logistic regression was used to identify factors associated with transfusion. Ninety-four adolescents were included (mean age 14.5±2.0 years), with a mean hemoglobin level at presentation of 7.47±1.63 g/dL. Blood transfusion was administered to 34 patients (36.2%). Lower hemoglobin levels at presentation and active bleeding were independently associated with transfusion. Follow-up hemoglobin measurements were available in 81 patients, with a mean increase of 3.28±1.91 g/dL during follow-up. The mean interval between hemoglobin measurements was 47.33±37.30 days. Although transfused patients showed greater hemoglobin increases in univariate analysis, transfusion was not independently associated with hemoglobin change after adjustment, whereas baseline hemoglobin level remained the only significant predictor of ΔHb. Baseline ferritin measurements were available in 76 patients, of whom 93.4% had ferritin levels <15 µg/L. Ferritin recovery lagged behind hemoglobin improvement, indicating slower restoration of iron stores during follow-up. Adolescents with HMB demonstrated substantial hemoglobin recovery during follow-up. However, restoration of iron stores appeared to occur more gradually, emphasizing the need for continued follow-up beyond hemoglobin normalization. While transfusion may be necessary in selected cases, it does not appear to independently determine hematologic recovery, supporting individualized transfusion strategies.
Sickle cell anemia (SCA) is highly prevalent in Central Africa. This disease causes severe manifestations in children, requiring treatment. Hydroxyurea (HU) is currently the most effective treatment for SCA. We evaluated the use of HU in children living in rural Central Africa. We conducted a clinical trial using HU in the Kisantu Saint Luc Hospital (KSLH) in the DR Congo (DRC) from November 2017 to February 2020. SCA patients aged 6 months to 18 years, with a moderate to severe form of SCA (Adegoke score), were treated with an entry HU dose of 15 mg/kg per day, followed with gradual dose escalation of 5 mg/kg per day increments every 6 months, up to a maximally tolerated dose of 30 mg/Kg/day. To determine the clinical and biological response to the treatment (efficacy of HU), we compared the clinical and biological data collected during the first and second year of treatment to the baseline values. Sixty-nine patients (37 boys and 32 girls; sex-ratio M/F 1.15) were eligible for the clinical trial using HU. Only 39 patients remained at the end of the clinical trial (56.5%). On average, the HbF increased to 3-fold at 12 months and 3.3-fold at 24 months, which was significantly different to the baseline. Thirty-seven (80.4%) patients presented a good clinical response, whereas 9 (19.6%) did not. This clinical demonstrated the clinical and biological effectiveness of HU treatment in a cohort of young Congolese patients. In addition to tremendous logistical challenges, low adherence is the major threat to HU treatment in a rural area. There is a need to implement appropriate strategies to increase the adherence to the HU treatment in these rural settings. Trial Registration: ClinicalTrials.gov identifier: NCT05681598.
Deferoxamine-induced bone dysplasia is a rare but clinically significant complication of chronic iron chelation therapy, characterized by metaphyseal abnormalities and growth disturbances. While conventional imaging demonstrates abnormal endochondral ossification, the extent of physeal involvement remains poorly understood. Diffusion tensor imaging (DTI) enables microstructural evaluation of physeal architecture and may provide additional insight beyond routine MRI. We report a 9-year-old skeletally immature male with Diamond-Blackfan anemia treated with chronic deferoxamine iron chelation therapy who presented with bilateral genu valgum confirmed on alignment radiographs. MRI revealed multiple metaphyseal cartilage tongues with areas of abnormal ossification in both distal femurs. DTI of both knees was performed to assess physeal integrity prior to guided growth surgery. Tractography demonstrated preserved bilateral physeal tracts with femoral physeal volumes of 15.9 mL (left) and 13.0 mL (right), and mean tract lengths of 6.9 ± 4.0 mm and 6.4 ± 3.3 mm, respectively. Despite metaphyseal abnormalities, tract volume and fractional anisotropy values suggested ongoing physeal activity. The patient subsequently underwent bilateral hemiepiphysiodesis with early postoperative improvement in alignment. In this case of deferoxamine-associated bone dysplasia, DTI demonstrated preserved physeal microarchitecture despite marked metaphyseal abnormalities on conventional MRI. Thus, DTI tractography may serve as a useful adjunct in evaluating physeal function and surgical candidacy in pediatric patients with growth disturbances. To the best of our knowledge, this is the first reported use of DTI in this condition and suggests a potential role for assessing physeal function and surgical candidacy in pediatric growth disturbances.
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Iron deficiency and hemoglobinopathies significantly impact public health, affecting morbidity, mortality, and quality of life. Their prevalence and consequences vary across populations, with Afro-descendant communities being of particular interest due to unique genetic, socioeconomic, and cultural factors. Subclinical iron deficiency, may go unnoticed in these populations, contributing to adverse health outcomes. This study aimed to determine the presence of iron deficiency, anemia, and hemoglobinopathies in Afro-descendant Populations of Colombia's Pacific coast. This descriptive, cross-sectional study included 198 Afro-descendant adults, both men and women, recruited through convenience sampling from various healthcare centers in the Pacific region. All participants provided written informed consent prior to enrollment. Blood samples were analyzed for total hemoglobin, ferritin levels, and hemoglobin variants. Only 18.1% of participants reported a previous anemia diagnosis. Low hemoglobin was found in 23.2% of participants, ferritin deficiency in 49%, and 33.8% presented subclinical iron deficiency (low ferritin with normal Hb). Hemoglobin variants were identified in 17% of participants: Hb AS 4.5%, Hb AC 3%, and HbSS 0.5%. Hemoglobin variants were significantly associated with low hemoglobin (OR = 10.6; 95% CI: 4.7-24.4; p < 0.001), as were low ferritin levels (OR = 2.32; 95% CI: 1.17 - 4.50; p = 0.01). The high frequency of subclinical iron deficiency, anemia, and hemoglobinopathies in this population highlights the urgent need for strategies focusing on prevention, early diagnosis, genetic counseling, and comprehensive health management in Afro-descendant populations.
Global under-5 mortality has fallen sharply since 1990, yet congenital and genetic disorders (ConGDs), spanning structural birth defects and inherited red-cell disorders (hemoglobinopathies and hemolytic anemias), have not previously been assessed as a composite burden. Effective interventions exist, but an implementation gap persists between availability and population-level delivery. We aimed to (1) quantify the temporal shift in the relative importance of ConGDs within under-5 mortality across 204 countries, and (2) apply frontier analysis to estimate avoidable ConGD mortality and identify intervention targets. Using GBD 2023, we aggregated 13 congenital and genetic causes (9 structural anomalies, 4 hemoglobinopathies and hemolytic anemias) for children under 5 from 1990 to 2023. We calculated age-standardized mortality rates (ASMR), proportional mortality ratios (PMR), and 95% uncertainty intervals (UI). Frontier analysis used log-transformed quantile regression (τ = 0.05) with natural cubic splines (df = 3) to estimate best-achievable mortality at each Socio-demographic Index (SDI) level. ConGD ASMR fell 29.4% (105.70 [95% UI 72.44-153.23] to 74.64 [49.50-114.00] per 100,000), far slower than the 64.7% decline in communicable, maternal, neonatal, and nutritional (CMNN) diseases. PMR almost doubled (5.59% [3.78-8.20] to 10.28% [6.70-15.98]), reflecting differential decline rather than rising incidence. ConGDs moved from the 4th to the 2nd leading cause of under-5 death. ASMR correlated negatively with SDI (ρ = - 0.78); the PMR-SDI relationship was positive but is a compositional artifact of faster all-cause mortality decline at higher SDI. Mortality concentrated neonatally (0-6 days) for structural defects but peaked in early childhood for hemoglobinopathies. Frontier analysis estimated up to 251,423 (95% CI 201,692-289,940) potentially avoidable deaths in 2023 (52.4% of total), with efficiency gaps at every SDI level. Nearly half of ConGD deaths in children under 5 are potentially avoidable. Three priority intervention targets emerge: (1) point-of-care newborn screening scale-up; (2) pediatric surgical capacity building for congenital heart defects; and (3) sickle cell chronic care programs that use proven therapies. A fourth, emerging opportunity lies in molecular diagnostics. Closing these gaps offers a high-impact route toward SDG 3.2.
The knowledge regarding Babesia canis infections in puppies is limited to 3 dogs aged 43-46 days. A 45-day-old, male intact German Shepherd dog was presented due to lethargy, inappetence, and gait disorders. An acute Babesia canis infection was diagnosed by PCR. Marked thrombocytopenia, anemia, and hyperbilirubinemia were noted. A subcutaneous injection of imidocarb dipropionate (ID, 2.0 mg/kg bodyweight) was applied. The puppy's general condition significantly improved, but vomitus was noted. A negative PCR and mild hematological abnormalities were seen 14 days later. A second subcutaneous injection of ID (4.2 mg/kg bodyweight) was applied. Babesia canis infections should be considered in puppies with fever, marked thrombocytopenia, and marked anemia in the immunological gap. Next to vectorial transmission, transplacental Babesia canis infections are reported but considered unlikely in the presented puppy. The puppy responded well to a lower-ranged dose of ID, but side effects were noted (vomiting). In adult dogs, treatment of acute Babesia canis infections using ID dosed 6.6 mg/kg bodyweight is recommended. No safety regulations are published by the manufacturer regarding the use of ID in puppies, but vomitus is reported as a potential side effect after the use in adult dogs. A second ID injection (4.2 mg/kg bodyweight) was applied to avoid a potential disease relapse. The case report highlights the significance of the immunological gap in puppies with Babesia canis infections and the need for ectoparasite prophylaxis in puppies, if vector contact is possible. Der Kenntnisstand bei Welpen mit akuten Babesia canis-Infektionen ist auf 3 Fälle im Alter von 43–46 Tagen beschränkt. Im vorliegenden Fallbericht wurde ein männlicher Deutscher Schäferhund-Welpe im Alter von 45 Tagen aufgrund von Lethargie, Inappetenz und Koordinationsstörungen vorgestellt. Eine akute Babesia canis-Infektion wurde mittels positiver PCR diagnostiziert. In der Blutuntersuchung waren eine hochgradige Thrombozytopenie, Anämie und Hyperbilirubinämie nachweisbar. Der Welpe wurde mit einer subkutanen Injektion von 2,0 mg/kg Körpergewicht Imidocarb Dipropionat (ID) behandelt, worauf sich der Allgemeinzustand besserte. Jedoch wurde von Vomitus berichtet nach der Injektion. Zwei Wochen später wurde eine negative PCR und geringgradige hämatologische Befunde festgestellt. Eine zweite subkutane ID-Injektion in der Dosierung 4,2 mg/kg Körpergewicht wurde verabreicht. Babesia canis-Infektionen sollten bei Welpen mit Zeckenbefall, Fieber, hochgradiger Thrombozytopenie und hochgradiger Anämie differentialdiagnostisch berücksichtigt werden. Auch transplazentare Babesia canis-Infektionen sind möglich, in diesem Fall jedoch unwahrscheinlich. Der Welpe reagierte gut auf die erste ID-Injektion in niedriger Dosierung, jedoch wurde Vomitus als mögliche Nebenwirkung berichtet. Allgemein wird bei akuten Babesia canis-Infektionen bei erwachsenen Hunden eine hohe Dosierung von 6,6 mg/kg Körpergewicht empfohlen. Vomitus ist als mögliche Nebenwirkung bei erwachsenen Hunden beschrieben, jedoch liegen keine Angaben zur Sicherheit und Verträglichkeit des ID bei Welpen vor. Die zweite ID-Injektion wurde vorgenommen, um einen klinischen Krankheitsrückfall zu vermeiden. Dieser Fallbericht unterstreicht die Bedeutung der immunologischen Lücke bei Welpen mit Babesia canis-Infektionen und die Bedeutung der Ektoparasitenprophylaxe bei Welpen mit möglichem Vektorkontakt.
Theileria spp. are tick-transmitted apicomplexan parasites that infect a variety of mammalian species. Although several species of Theileria infect ungulates of North America, from a historical perspective, reports of clinical disease are relatively sporadic. Herein we report an outbreak of theileriosis in captive deer following transport from Illinois to Iowa, USA. Although the facility housed both whitetail and mule deer, only mule deer were affected clinically by lethargy, anorexia, and anemia. Post-mortem examination revealed pleural effusion, mucous membrane pallor, and splenomegaly. Microscopically, there was evidence of erythrocyte degradation in multiple organs. Evaluation of blood smears revealed intraerythrocytic piroplasm-like organisms. Collection of ticks from the affected premises yielded a mixed population of Dermacentor variabilis and Amblyomma americanum. Polymerase chain reaction and sequencing of DNA from ticks and affected deer was consistent with Theileria cervi. Although T. cervi appears to be an infrequent cause of disease in North American cervids it is possible that animals develop immunity to local variants which is ineffective upon transport to an area with other isolates. Our findings, in combination with previous reports, indicate that mule deer may be more susceptible to isolates of T. cervi in areas outside of mule deer's native range. T. cervi should be considered as a differential diagnosis for anemia in cervids, particularly those transported and introduced to new habitats or populations of ticks in North America.