Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by erythrocytosis, typically driven by JAK2 mutations. Diagnosis can be challenging when concurrent conditions mask the underlying erythrocytosis. Iron deficiency is the most common masking factor; however, to the authors' knowledge, this is the first reported case in which the combination of iron deficiency and pernicious anemia created a dual masking mechanism. A 68-year-old Hispanic female patient with a history of chronic anemia presented with severe symptomatic anemia requiring transfusion (hemoglobin 5.2 g/dL). Evaluation revealed iron deficiency anemia and pernicious anemia secondary to autoimmune gastritis, confirmed by positive intrinsic factor and anti-parietal cell antibodies. Following intravenous iron and intramuscular vitamin B12 repletion, hemoglobin normalized. However, the patient subsequently developed progressive erythrocytosis, with hemoglobin rising to 19.8 g/dL and hematocrit to 58.7%. Evaluation revealed suppressed erythropoietin (2.1 mIU/mL), negative molecular testing for JAK2, CALR, and MPL mutations, and exclusion of secondary causes. Repeat bone marrow biopsy demonstrated marked hypercellularity with trilineage panmyelosis and clusters of enlarged pleomorphic megakaryocytes with hyperlobulated nuclei, establishing the diagnosis of JAK2-unmutated PV. This case illustrates a rare presentation of masked PV in which concurrent iron deficiency and pernicious anemia from autoimmune gastritis simultaneously obscured the underlying myeloproliferative process. The dramatic hemoglobin swing from 5.2 g/dL to 19.8 g/dL, observed during clinical follow-up after correction of the iron and vitamin B12 deficiencies, served as the key diagnostic clue. Clinicians should maintain vigilance for underlying myeloproliferative neoplasms when erythrocytosis develops following correction of nutritional deficiencies, even in the absence of canonical driver mutations. In JAK2-unmutated cases, bone marrow morphology becomes the cornerstone of diagnosis.

Angioleiomyoma is a rare, smooth muscle tumor of vascular origin, which primarily affects the skin. A 9-year-old, castrated male dog presented for transient ataxia. Abnormalities were not detected on physical examination, but blood tests revealed a mild, severely microcytic anemia and transferrin saturation of 2.5% (reference interval, 27%-66%). An exhaustive diagnostic work-up ensued but failed to find the cause of the severe iron deficiency in laboratory, imaging, and endoscopic studies. Severely microcytic anemia had persisted for 6 months, despite iron-dextran injections, and in the absence of clinical signs, until intussusception developed. The abnormal jejunal segment was removed and diagnosed as angioleiomyoma, based on characteristic histological features, positive immunolabeling with α-smooth muscle actin and CD31, and negative S100 and c-Kit/CD117 staining. Hitherto unreported in dogs, intestinal angioleiomyoma was associated with protracted, occult, asymptomatic intestinal blood loss, until intussusception developed. Prognosis appears favorable with full excision, based on clinical behavior in other organs, and the present case.

Introduction: Background: Anorexia nervosa (AN) is associated with severe dietary restriction and multisystem effects of undernutrition, but biochemical micronutrient status does not necessarily parallel dietary intake or body weight. This scoping review mapped biological evidence on vitamin, mineral, trace-element, and electrolyte status in AN. Methods: The review was structured using JBI scoping review methodology and is reported according to PRISMA-ScR. PubMed/MEDLINE, Scopus, Web of Science Core Collection, and supplementary Google Scholar searching were used from inception to 30 March 2026, together with backward reference-list screening. Eligibility was defined using the Population-Concept-Context framework. Original human studies containing a clearly identifiable AN population and reporting biological micronutrient markers were eligible; refeeding studies, case reports/series, and diagnostically mixed cohorts were retained when relevant but were distinguished from AN-specific comparative or cohort evidence. Data were charted by design, population, biological matrix, timing, and nutrient outcome and synthesized narratively. Results: Database searching identified 621 records; 109 studies met eligibility criteria, and reference-list screening added 27 studies, yielding 136 included sources. Findings were heterogeneous and did not support universal biochemical depletion. Phosphorus was frequently preserved at admission but declined during refeeding in many cohorts. Potassium, sodium, and magnesium abnormalities were most evident in medically unstable, purging, or refeeding contexts. Serum calcium was commonly preserved despite impaired bone health. Iron deficiency was uncommon in many cohorts despite anemia and altered ferritin, transferrin, or hepcidin. Selenium, zinc, and vitamin D were recurrently low in several studies, whereas vitamin B12 was more often normal or elevated than deficient. Conclusions: AN is characterized by context-dependent micronutrient dysregulation rather than uniform deficiency. Interpretation should account for study design, illness stage, purging behavior, supplementation, refeeding, biological matrix, and the limitations of circulating biomarkers. Normal serum or plasma concentrations do not necessarily exclude depleted tissue stores, functional insufficiency, or refeeding risk. Interpretation is prioritized by study design, sample size, biological matrix and treatment stage rather than numerical direction-of-finding counts. This review maps monitoring-relevant abnormalities but does not establish the efficacy of supplementation strategies.

Background: Milk feeding practices are a critical determinant of nutritional status in infancy, yet the relationship between specific milk feeding combinations and undernutrition remains poorly characterized in Pakistan, where animal milk use is widespread and the malnutrition burden is among the highest in South Asia. Methods: We pooled data on 96,736 children aged 6-23 months with valid anthropometry from 13 nationally and provincially representative cross-sectional surveys (2010-2020). Analyses were restricted to Punjab, Sindh, Khyber Pakhtunkhwa and Balochistan. Seven mutually exclusive feeding combinations were defined from 24 h dietary recall. Survey-weighted, age-stratified logistic regression (6-11 and 12-23 months) examined associations with stunting and wasting, adjusting progressively for area, household and child-level factors, with breastfeeding plus complementary feeding as the reference. Micronutrient deficiency data from NNS 2011 and NNS 2018 were analyzed descriptively. Results: Among infants aged 6-11 months, non-human milk (NHM) alone-predominantly unfortified buffalo or cow milk-was independently associated with elevated odds of stunting (OR: 1.54, 95% CI: 1.20-1.96) and wasting (OR: 1.86, 95% CI: 1.42-2.45) in fully adjusted models. Among children aged 12-23 months, NHM with complementary foods (NHM+CF) was independently protective against both stunting (OR: 0.73, 95% CI: 0.66-0.80) and wasting (OR: 0.80, 95% CI: 0.72-0.89). Household poverty was the strongest determinant of undernutrition in every stratum. Anemia (59.1%), ferritin deficiency (50.4%), iron deficiency anemia (33.0%) and vitamin D deficiency (63.1%) remained highly prevalent in 2018, and were highest in children receiving milk without complementary foods. In contrast, multiple micronutrient deficiency was elevated across most NHM-containing feeding groups regardless of complementary food status; after adjustment, NHM+CF and BM+NHM remained independently associated with multiple micronutrient deficiency at 12-23 months (OR: 1.35, 95% CI: 1.04-1.77 and OR: 1.52, 95% CI: 1.05-2.20, respectively). Conclusions: The nutritional correlates of NHM use are strongly age-dependent: adverse in the first year when it substitutes for breast milk without complementary foods, and favorable after 12 months as part of a diversified diet. Feeding interventions should be embedded within poverty-reduction frameworks. All data were cross-sectional, so these associations are not causal.

Background/Objectives: Anemia and abnormalities in iron-related biomarkers are common in chronic heart failure (CHF), but their relationships with biological sex and left ventricular ejection fraction (LVEF) remain incompletely understood. This study assessed sex-related differences in hematological, iron-related, oxidative stress, and purine metabolism biomarkers across CHF phenotypes. Methods: This cross-sectional observational study included 180 patients with CHF, classified according to sex, anemia status based on World Health Organization sex-specific hemoglobin thresholds, and LVEF category: heart failure with preserved ejection fraction (HFpEF), mildly reduced ejection fraction (HFmrEF), or reduced ejection fraction (HFrEF). Hematological parameters, serum iron, ferritin, plasma and erythrocyte purine metabolites, oxidative modification of proteins (OMB), and advanced oxidation protein products (AOPPs) were evaluated. Group comparisons were performed using the Kruskal-Wallis and Mann-Whitney U tests, with Benjamini-Hochberg false discovery rate correction for multiple testing. Results: After multiple-testing correction, none of the biomarker comparisons across LVEF categories remained statistically significant when women and men were analyzed separately. Among women with HFpEF, median ferritin was 33.0 μg/L overall and 20.35 μg/L among those with anemia; however, these values could not be used to determine the mechanism of iron deficiency. Among men, anemia was associated with a higher platelet count in HFpEF (287 versus 203 × 10[9]/L; q < 0.009) and lower serum iron concentrations in HFpEF (8.8 versus 18.1 μmol/L; q = 0.029) and HFrEF (5.5 versus 12.0 μmol/L; q = 0.036). In direct comparisons between sexes, only the higher hemoglobin concentration in men with HFmrEF remained statistically significant after correction (148 versus 121 g/L; q < 0.036). Nominal differences in plasma purines, hypoxanthine, and xanthine between anemic men and women with HFrEF did not remain statistically significant after correction (all q = 0.147). Conclusions: The findings demonstrate exploratory associations between sex, anemia status, LVEF category, and selected laboratory biomarkers but do not establish sex-specific mechanisms of anemia or purine metabolism alterations in CHF. Because transferrin saturation, transferrin-related indices, soluble transferrin receptor, hepcidin, and inflammatory biomarkers were not measured, the observed iron-related patterns cannot be classified as absolute iron deficiency or inflammation-associated functional iron restriction. Larger studies incorporating formal interaction testing, multivariable adjustment, and comprehensive assessment of iron status are required.

This study developed a dietary polysaccharide-stabilized peptide-Fe2+ composite beverage to address iron deficiency anemia (IDA). Through single-factor and orthogonal experiments, the formulation was optimized (cranberry/blueberry concentrate ratio 4:6, 600 mL/L; FA-COS@Peptide-Fe2+@PTry-CMC 200 mL/L; vitamin C 1.5 g/L; pectin 0.06 g/L), and processing parameters were determined (homogenization: 12,000 rpm, 20 min; sterilization: 95 °C, 15 min). Storage stability was optimal at 4 °C in dark conditions. Under the optimal processing conditions, the beverage attained a maximum suspension stability of 17.74% and the optimized formulation achieved a highest sensory score of 94.0 (out of 100). In vivo experiments showed that the beverage dose-dependently restored hematological parameters (e.g., HGB, SI, TIBC) and tissue iron levels, alleviated intestinal oxidative stress and inflammatory markers in IDA mice, while repairing colonic mucosal damage without adverse effects. The beverage demonstrated high iron-supplementing efficacy and excellent biosafety, offering a promising strategy for IDA intervention.

In Senegal, 39.1% of children aged 5－17 years are affected by iron deficiency. Although fortification is a major mitigation strategy in Senegal, its full potential has not been reached in terms of public health impact due to factors linked to the characteristics of the food vehicle, availability, and acceptability by the target group from both an ethical and sensory standpoint. In this context, this study proposes a robust method for the rapid development of an iron-rich biscuit formulation to prevent iron deficiency among school-aged children. Nine biscuit formulations were developed based on local products using a mixture design, and the physicochemical and microbiological compositions were assessed. Hedonic tests were conducted using a balanced incomplete block design, followed by the "Just About Right" sensory evaluation test. The iron content of the biscuits was higher (3.4－5.8 mg/100 g) than that of commercial biscuits (0.4 mg/100 g). The biscuits were well appreciated, with scores averaging between 6.0 (like slightly) and 7.7 (like very much). Increasing the proportion of millet flour enhanced the iron content but reduced sensory acceptability. The mixture design was optimized with respect to overall appreciation and iron content. The best formula contained wheat, corn, and millet at 26.00, 18.17, and 7.82 g, respectively, per 100 g of dough, corresponding to an iron content of 4 mg/100 g and a hedonic score of 6.97. This research highlights the potential of local ingredients to produce affordable, nutritious, and well-accepted food vehicles, which are key to the prevention of iron deficiency anemia in school-aged children.

Anemia is a common complication in patients with chronic kidney disease and cancer and is increasingly observed with declining kidney function. When chronic kidney disease and malignancy coexist, overlapping mechanisms, including reduced erythropoietin production, iron-restricted erythropoiesis driven by inflammation and hepcidin, myelosuppression from anticancer therapy, marrow infiltration, bleeding, and nutritional deficiencies, create diagnostic uncertainty and limit straightforward extrapolation from chronic kidney disease- or oncology-only anemia guidance. In this consensus-based guideline, we summarize the pathophysiology and clinical impact of anemia in patients with concomitant chronic kidney disease and cancer, outline a practical diagnostic approach, and provide consensus recommendations for management. We highlight key therapeutic uncertainties regarding the use of iron therapy, erythropoiesis-stimulating agents, and red blood cell transfusion thresholds, and we discuss emerging therapies, such as hypoxia-inducible factor prolyl hydroxylase inhibitors in the setting of malignancy. This position statement on behalf of the American Society of Onconephrology provides a unified, patient-centered framework to support individualized decision-making that balances efficacy, safety, and goals of care in this increasingly prevalent and complex population.

Plummer-Vinson syndrome (PVS), also known as Paterson-Kelly syndrome or sideropenic dysphagia, is a rare disorder characterized by the triad of iron deficiency anemia, dysphagia, and esophageal webs. It predominantly affects middle-aged women and sometimes carries a risk of malignant transformation to esophageal and hypopharyngeal carcinoma, which makes early recognition clinically significant. This case report describes a 37-year-old woman who presented with a four-month history of a burning sensation and dysphagia to solid foods. Her physical examination revealed pale palpebral conjunctiva, and intraoral examination showed pale, pigmented buccal mucosa bilaterally, along with dental caries and multiple missing maxillary posterior teeth. Hematological investigations revealed severe microcytic hypochromic anemia with low serum ferritin, consistent with iron deficiency, and a barium swallow study demonstrated an esophageal stricture, confirming the diagnosis of PVS. The patient was advised to undergo prosthetic rehabilitation of her missing teeth to support adequate mastication and nutrient absorption, and was referred to a gastroenterologist for further management of the esophageal stricture and to a general physician for correction of iron deficiency anemia. This report highlights the clinical presentation, oral and hematological findings, diagnostic workup, and multidisciplinary management of PVS, and underscores the value of prompt barium swallow evaluation and gastroenterology referral in patients with iron deficiency anemia and dysphagia, given the syndrome's potential for malignant transformation.