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Anemia

Anemic

Anemia is defined as a decrease in red blood cell mass. The three main causes include blood loss, increased red blood cell destruction (hemolysis) and decreased production of red blood cells. Iron deficiency is thought to be the most common cause of anaemia globally. Common symptoms are weakness, fatigue, general malaise and dyspnea on exertion. Serious complications of severe anemia arise from tissue hypoxia (shock, hypotension, etc.).


Presentation

In the preliminary stages, mild form of anemia has no symptoms. However, when the condition progresses, then the individuals experience the following:

  • Poor concentration
  • Feeling tired more often than usual
  • Occurrence of headaches
  • Chest pain
  • Hands and feet become cold
  • Shortness of breath
  • Irregular or fast heartbeat
  • Dizziness 
  • Development of pale skin

In more severe cases, individuals would also develop lightheadedness especially when they stand up, development of bluish color in the eyes; nails become brittle and sore tongue [6].

Fatigue
  • . — Cathleen O'grady, Ars Technica , "Large genetic study finds first genes connected with ADHD," 27 Nov. 2018 Other common anemia symptoms include weakness, fatigue, an irregular heartbeat, paler skin, chest pain, and headaches. — Carolyn L.[merriam-webster.com]
  • The Vitality and Physical functioning domains of the SF-36 and the FACT-An Total, Fatigue and Anemia subscales were identified as domains relevant to CKD-associated anemia.[ncbi.nlm.nih.gov]
  • A 27-year-old previously healthy woman was admitted with echymotic patches over the lower limbs for six months, multiple joint pain and fatigue for 2 months. She had severe pallor and multiple echymotic patches over the lower limbs.[ncbi.nlm.nih.gov]
  • PATIENT CONCERNS: Our case was a 58-year-old female affected by dizziness and fatigue for nearly a month. Blood tests revealed anemia and thrombocytopenia, and pathological results of a bone marrow biopsy confirmed the metastatic carcinoma.[ncbi.nlm.nih.gov]
  • Acute anemia presents with symptoms owing to acute blood loss; chronic anemia may present with worsening fatigue, dyspnea, lightheadedness, or chest pain. Specific treatments depend on the underlying anemia and etiology.[ncbi.nlm.nih.gov]
Weakness
  • (Grade: weak recommendation; low-quality evidence) ACP recommends against the use of erythropoiesis-stimulating agents in patients with mild to moderate anemia and congestive heart failure or coronary heart disease.[ncbi.nlm.nih.gov]
  • Symptoms of anemia may include the following: Fatigue weakness shortness of breath lightheadedness palpitations (feeling of the heart racing or beating irregularly) looking pale Symptoms of severe anemia may include: chest pain , angina , or heart attack[web.archive.org]
  • This can cause you to feel tired or weak. You may also have shortness of breath, dizziness, headaches, or an irregular heartbeat. There are many types and causes of anemia. Mild anemia is a common and treatable condition that can occur in anyone.[nhlbi.nih.gov]
  • Symptoms Individuals with anemia suffer from fatigue, weakness, headache, and lightheadedness, pale color of the skin, brittle nails and concentration problems.[symptoma.com]
Pallor
  • She had severe pallor and multiple echymotic patches over the lower limbs. She was diagnosed with SLE with pernicious anemia and iron deficiency anemia. The rare association of SLE with pernicious anemia was reported previously in few patients.[ncbi.nlm.nih.gov]
  • Pallor has poor sensitivity for predicting mild anemia, but correlates well with severe anemia. 11 – 13 One study showed that physical examination findings of pallor of the conjunctivae, tongue, palm, or nail beds is 93 percent sensitive and 57 percent[aafp.org]
  • Signs and symptoms of anemia may include pallor of the skin and mucous membranes, shortness of breath, palpitations of the heart, soft systolic murmurs, lethargy, and fatigability.[fpnotebook.com]
  • Jennifer Cobelli Kett , MD Children’s National Medical Center Washington, DC Suggested Reading Anemia and Pallor . Kolb EA, Levy AS. In: McInerny TK, Adam HM, Campbell DE, Kamat DM, Kelleher KJ, eds.[pedsinreview.aappublications.org]
Weight Loss
  • […] successful weight loss in humans.[ajcn.org]
  • Researchers ... read more Long-Term Follow-Up After Weight-Loss Surgery Finds High Rate of Anemia Sep. 20, 2017 — Researchers found a high rate of anemia 10 years after patients received Roux-en-Y gastric bypass, suggesting that long-term follow-up with[sciencedaily.com]
  • People who have had gastric bypass surgery for weight loss or other reasons may also be iron deficient due to poor absorption.[hematology.org]
  • People with colon or rectal cancer may have weight loss, fatigue (excessive weakness), loss of appetite, and a family history of cancer. Everyone over the age of 50 should be screened with a sigmoidoscopy.[chemocare.com]
  • Loss of Appetite/Weight Loss Co-existing Conditions Pernicious Anaemia is an Autoimmune Disease. Autoimmune Diseases are characterised by the body somehow attempting to destroy itself.[pernicious-anaemia-society.org]
Congestive Heart Failure
  • (Grade: weak recommendation; low-quality evidence) ACP recommends against the use of erythropoiesis-stimulating agents in patients with mild to moderate anemia and congestive heart failure or coronary heart disease.[ncbi.nlm.nih.gov]
  • CHD coronary heart disease; CHF congestive heart failure; ESA erythropoiesis-stimulating agent; RCT randomized, controlled trial. 30-d mortality among patients with congestive heart failure or coronary heart disease in liberal versus restrictive blood[doi.org]
  • English-language trials of blood transfusions, iron, or erythropoiesis-stimulating agents in adults with anemia and congestive heart failure or coronary heart disease and observational studies of transfusion.[ncbi.nlm.nih.gov]
  • heart failure. 35,36 Estimates of anemia prevalence range from less than 10% in mild heart failure to greater than 40% in advanced heart failure. 29 Anemia in congestive heart failure may be caused by excessive cytokine production, among other factors[ajmc.com]
  • Recommendation 2: ACP recommends against the use of erythropoiesis-stimulating agents in patients with mild to moderate anemia and congestive heart failure or coronary heart disease.[doi.org]
Dyspnea
  • Acute anemia presents with symptoms owing to acute blood loss; chronic anemia may present with worsening fatigue, dyspnea, lightheadedness, or chest pain. Specific treatments depend on the underlying anemia and etiology.[ncbi.nlm.nih.gov]
  • […] toddlerhood 2 Iron deficiency Inadequate dietary intake, chronic occult blood loss (excessive cow's milk consumption, inflammatory bowel disease, Meckel diverticulum, parasites) Usually asymptomatic; severe cases can present with fatigue, pallor, or dyspnea[aafp.org]
  • Symptoms may include: Abnormal paleness or lack of color of the skin Increased heart rate (tachycardia) Breathlessness, or difficulty catching a breath (dyspnea) Lack of energy, or tiring easily (fatigue) Dizziness, or vertigo especially when standing[chop.edu]
  • Common symptoms are weakness, fatigue, general malaise and dyspnea on exertion. Serious complications of severe anemia arise from tissue hypoxia (shock, hypotension, etc.). In the preliminary stages, mild form of anemia has no symptoms.[symptoma.com]
  • Patients with anemia may present with fatigue, dizziness and dyspnea; however, mild anemia shows few clinical signs or symptoms.[dx.doi.org]
Loss of Appetite
  • Nausea, vomiting, and loss of appetite. Nausea and vomiting and loss of appetite may cause a lack of nutrients. The body needs these nutrients to make red blood cells. These include iron, vitamin B12, and folic acid. Excessive bleeding.[cancer.net]
  • Symptoms that may occur first include: Feeling weak or tired more often than usual, or with exercise Headaches Problems concentrating or thinking Irritability Loss of appetite Numbness and tingling of hands and feet If the anemia gets worse, symptoms[medlineplus.gov]
  • People with colon or rectal cancer may have weight loss, fatigue (excessive weakness), loss of appetite, and a family history of cancer. Everyone over the age of 50 should be screened with a sigmoidoscopy.[chemocare.com]
Abdominal Pain
  • Inflammatory bowel disease -Diarrhea, abdominal pain and mucous in your bowel movements are caused by inflammation (swelling and redness) of the lining of the colon. This may cause rectal bleeding.[chemocare.com]
  • Extremely large spleens cause abdominal pain and a feeling of fullness after eating a small amount of food. Often, an enlarged spleen also traps platelets and white blood cells, thus reducing their number in the bloodstream.[merckmanuals.com]
  • pain, altered mental status, renal disease, and hypertension Microcytic anemia may be concurrent with iron deficiency; peripheral smear may show basophilic stippling; hemolysis may be present Late childhood and adolescence 2 Iron deficiency Second peak[aafp.org]
  • Children may present with abdominal pain, lethargy, anorexia, and pallor (from anemia). Ataxia, speech difficulties, seizures, and coma may occur in some patients.[emedicine.com]
  • Table 2 Comparison of the intravenous iron preparations Intravenous iron sucrose is reasonably well tolerated (35% of patients have mild side effects including abdominal pain, nausea, headache and diarrhoea), with a low incidence of serious adverse reactions[doi.org]
Palpitations
  • Symptoms of anemia may include the following: Fatigue weakness shortness of breath lightheadedness palpitations (feeling of the heart racing or beating irregularly) looking pale Symptoms of severe anemia may include: chest pain , angina , or heart attack[web.archive.org]
  • Severe anemia may lead to shortness of breath, pale complexion, dry nails, palpitations etc. Children with anaemia, like adults, may appear pale, tired and short of breath.[news-medical.net]
  • Signs and symptoms of anemia may include pallor of the skin and mucous membranes, shortness of breath, palpitations of the heart, soft systolic murmurs, lethargy, and fatigability.[fpnotebook.com]
  • Both anxiety and anemia cause: Shortness of breath Heart palpitations Tingling in extremities Fatigue Weakness However, while anemia may cause these symptoms, it also often leads to other, more serious problems that cause hospitalization.[calmclinic.com]
Hypotension
  • HBO was discontinued in the survivors when they no longer suffered from hypoxic sprue, postural hypotension, and usually when the Hct was 22% or greater and the Hb was 7 g/dl or greater.[archive.rubicon-foundation.org]
  • Serious complications of severe anemia arise from tissue hypoxia (shock, hypotension, etc.). In the preliminary stages, mild form of anemia has no symptoms.[symptoma.com]
  • Hypovolemia leads to hypotension, which is detected by stretch receptors in the carotid bulb, aortic arch, heart, and lungs.[web.archive.org]
  • Consider type O or type-specific blood transfusion for patients who remain hypotensive after 2 L of crystalloid infusion; this applies to young healthy patients with a hematocrit below 20% and elderly patients with a hematocrit below 30%.[emedicine.com]
Heart Murmur
  • murmur enlargement of the spleen with certain causes of anemia Next: When to Seek Medical Care »[web.archive.org]
  • murmur Low blood pressure, especially when you stand up Slight fever Pale skin Rapid heart rate Some types of anemia may cause other findings on a physical exam.[medlineplus.gov]
  • Your physician may detect a heart murmur or note a significant decrease in your blood pressure when you stand. A blood sample will provide an overall count of your white blood cells , red blood cells and platelets .[radiologyinfo.org]
  • murmur increased heart rate enlarged spleen enlarged liver Hemolytic disease of the newborn is a condition that occurs when a mother and baby have incompatible blood types.[healthline.com]
Tachycardia
  • Symptoms may include: Abnormal paleness or lack of color of the skin Increased heart rate (tachycardia) Breathlessness, or difficulty catching a breath (dyspnea) Lack of energy, or tiring easily (fatigue) Dizziness, or vertigo especially when standing[chop.edu]
  • Physical examination may show jaundice, tachypnea, tachycardia, and heart failure, especially in children with severe or acute anemia.[aafp.org]
  • Cardiac exam for tachycardia (acute blood loss or sepsis), murmurs (hemolysis due to endocarditis or a mechanical valve), or signs of volume overload.[clinicaladvisor.com]
  • Class I ( Class II (15-30% blood loss) – Tachycardia, tachypnea, and a decreased pulse pressure are seen.[emedicine.com]
  • In severe anemia, there may be signs of a hyperdynamic circulation: tachycardia (a fast heart rate), bounding pulse, flow murmurs, and cardiac ventricular hypertrophy (enlargement). There may be signs of heart failure.[en.wikipedia.org]
Systolic Murmur
  • Signs and symptoms of anemia may include pallor of the skin and mucous membranes, shortness of breath, palpitations of the heart, soft systolic murmurs, lethargy, and fatigability.[fpnotebook.com]
Tinnitus
  • Tinnitus This is extremely common in patients with PA and is probably due to slight nerve damage to the brain. Sensory Impairment Loss of smell, taste, touch Irritability/Frustration/Impatience A general feeling of unease.[pernicious-anaemia-society.org]
Dry, Brittle Hair
  • , brittle hair, and hair loss, especially near the outer edge of the eyebrows Brittle, dull, and thin nails Decreased sweating Swelling of the hands, face, and eyelids (called edema) "Brain Fog" Another symptom commonly described in connection with hypothyroidism[verywell.com]
Restless Legs Syndrome
  • Treatment of restless legs syndrome in adults. Wolters Kluwer Health. 2014; 30. Scholz H, Trenkwalder C, Kohnen R, Riemann D, Kriston L, Hornyak M. Dopamine agonists for restless legs syndrome.[doi.org]
  • leg syndrome When kids eat non-foods: Children with anemia caused by very low levels of iron in their blood may also eat strange non-food things such as ice, dirt, clay, paper, cardboard, and cornstarch.[healthychildren.org]
  • In adults, ID is associated with fatigue in the absence of anemia, restless legs syndrome, pica and, in neonates, delayed growth and development. In adolescents, ID is associated with decrements in learning and behavioral abnormalities.[dx.doi.org]
  • Restless legs syndrome is more common in those with iron-deficiency anemia.[en.wikipedia.org]
Dizziness
  • PATIENT CONCERNS: Our case was a 58-year-old female affected by dizziness and fatigue for nearly a month. Blood tests revealed anemia and thrombocytopenia, and pathological results of a bone marrow biopsy confirmed the metastatic carcinoma.[ncbi.nlm.nih.gov]
  • Symptoms of anemia may include the following: Fatigue weakness shortness of breath lightheadedness palpitations (feeling of the heart racing or beating irregularly) looking pale Symptoms of severe anemia may include: chest pain , angina , or heart attack dizziness[web.archive.org]
  • You may also have shortness of breath, dizziness, headaches, or an irregular heartbeat. There are many types and causes of anemia. Mild anemia is a common and treatable condition that can occur in anyone.[nhlbi.nih.gov]
  • You also may have other symptoms, such as shortness of breath, dizziness, or headaches. Severe or long-lasting anemia can damage your heart, brain, and other organs in your body. Very severe anemia may even cause death.[web.archive.org]
Headache
  • Who Is at Risk for Iron Deficiency Headaches? As a general rule, women are more susceptible to both iron deficiencies and headaches. But this doesn’t mean that men can’t develop these types of headaches as well.[fergon.com]
  • You may also have shortness of breath, dizziness, headaches, or an irregular heartbeat. There are many types and causes of anemia. Mild anemia is a common and treatable condition that can occur in anyone.[nhlbi.nih.gov]
  • You also may have other symptoms, such as shortness of breath, dizziness, or headaches. Severe or long-lasting anemia can damage your heart, brain, and other organs in your body. Very severe anemia may even cause death.[web.archive.org]
  • . — Cathleen O'grady, Ars Technica , "Large genetic study finds first genes connected with ADHD," 27 Nov. 2018 Other common anemia symptoms include weakness, fatigue, an irregular heartbeat, paler skin, chest pain, and headaches. — Carolyn L.[merriam-webster.com]
Apathy
  • Culture definitions for anaemia anemia [(uh- nee -mee-uh)] Note Because people suffering from anemia often appear weak and pale, the term is frequently used to describe general apathy or weakness: “The team's performance has been pretty anemic these past[dictionary.reference.com]
  • Fatigue, sleepiness, slowing of speech, in addition to a lack of interest in personal relationships and general apathy, are signs of depression and hypothyroidism.[verywell.com]
Vertigo
  • Symptoms may include: Abnormal paleness or lack of color of the skin Increased heart rate (tachycardia) Breathlessness, or difficulty catching a breath (dyspnea) Lack of energy, or tiring easily (fatigue) Dizziness, or vertigo especially when standing[chop.edu]
  • Vertigo The inability to cope with heights and wide open spaces. Patients will need a visual reference to compensate with what is probably damage to the brain’s balance mechanism.[pernicious-anaemia-society.org]
Numbness of the Hand
  • Other symptoms include dizziness, headaches, numbness in your hands or feet, low body temperature, pale skin, shortness of breath, rapid or irregular heartbeat, chest pain, irritability, and not performing well at work or school.[prevention.com]
Amenorrhea
  • […] rate (tachycardia) Breathlessness, or difficulty catching a breath (dyspnea) Lack of energy, or tiring easily (fatigue) Dizziness, or vertigo especially when standing Headache Irritability Irregular menstruation cycles Absent or delayed menstruation (amenorrhea[chop.edu]

Workup

The following methods are employed to diagnose anemia:

  • Physical examination is done to carefully evaluate the signs and symptoms of anemia. In this, the heartbeat is studied along with other physical parameters such as size of the liver and spleen [7].
  • Blood tests to obtain a complete blood count would be made. The levels of hemoglobin are of primary interest. According to the values provided by WHO, males with hemoglobin values lower than 13.5g/dL and women with less than 12.5g/dL are considered to anemic. Blood tests in most cases also help identify the presence of underlying disease condition if any.
  • Other tests would be carried out to establish the size and shape of the red blood cells. This is necessary because the size and shape of the cells changes with the type of anemia present. Individuals with iron deficiency anemia have smaller sized red blood cells; whereas those with vitamin deficiency anemia have enlarged RBCs [8].
Hemoglobin Decreased
  • However, when the hemoglobin decreases and the bone marrow does not have regenerative capacity, the expected increase in reticulocytes fails, despite the increase in erythropoietin plasma level (hypo-regenerative anemia)[ 12 ].[dx.doi.org]
Erythrocytes Decreased
  • Throughout fetal life, erythrocytes decrease in size and increase in number: hematocrit increases from 30% to 40% during the second trimester to 50% to 63% at term.[pedsinreview.aappublications.org]
Hypercellular Bone Marrow
  • Clinics RA usually presents with hypercellular bone marrow (BM) and anemia. There may be leukopenia and/or and thrombocytopenia, but these features do not represent a diagnostic requirement.[atlasgeneticsoncology.org]

Treatment

Treatment of anemia depends on its type. The following methods are employed to treat different types of anemia:

  • Iron deficiency anemia is treated with iron supplements and changes in dietary pattern [9].
  • B12 deficiency anemia can be treated with providing supplements of folate and vitamin B12. These nutrients are also provided through diet. In case, the body is unable to absorb these through diet then vitamin B12 injections are given.
  • Anemia due to chronic disease condition has no specific treatment regime. In this, modes are employed for treating the underlying disease condition. When symptoms turn severe then, blood transfusion may be necessary.
  • Aplastic anemia is treated through blood transfusions and bone marrow transplantation.
  • Sickle cell anemia may require blood transfusions, antibiotics and supplements of folic acid. In certain cases, bone marrow transplant may be indicated.
  • Thalassemia is primarily treated through blood transfusions. In many instances, splenectomy and bone marrow transplant would be required [10].

Prognosis

The prognosis depends on the type of anemia and the causative factors. Mild forms can be successfully treated with supplements and intake of iron rich diet. However, certain forms can be severe and require a more rigorous treatment regime. Such types include sickle cell anemia, thalassemia and aplastic anemia. Anemia that results from aortic rupture has a very poor prognosis with about 80% mortality rate [5].

Etiology

Anemia occurs due to any of the 3 causes which include; loss of blood, decreased production of red blood cells and hemolysis characterized by increased destruction of red blood cells. There are several causative factors such as genetic, nutritional, physical and underlying disease conditions that can give rise to anemia.

  • Genetic factors such as development of thalassemia, heredity xerocytosis, Fanconi anemia, Rh null disease and defects in RBC cytoskeleton can lead to anemia.
  • Nutritional deficiencies including deficiency of iron, folate and vitamin B12 can cause anemia to set in.
  • Physical factors that can cause blood loss include burns, trauma, prosthetic valves and frostbite can lead to development of anemia.
  • Underlying disease conditions such as neoplasia, renal disease, liver disease and collagen vascular disease can predispose an individual to develop anemia [2].

Epidemiology

It has been estimated that, about 1 billion individuals across the globe suffer from iron deficiency anemia. Women and children are more affected than men. According to WHO, men and women having hemoglobin levels below 12.5g/dL are considered to be suffering from anemia. For the US population, levels of 12.5g/dL for women and 13.5g/dL for men are considered to be cut off values. Based on these values, 4% men and 8% women are known to have lower than normal hemoglobin levels in the US [3].

Sex distribution
Age distribution

Pathophysiology

Under normal physiologic conditions, the red blood cells (RBCs) of the body contain hemoglobin. The RBCs with the help of hemoglobin are responsible for carrying oxygen to the lungs and various other parts of the body. They also carry carbon dioxide from parts of the body to the lungs for it to be exhaled. Red blood cells are made regularly in the bone marrow. For the bone marrow to produce RBCs and hemoglobin, it needs adequate amounts of iron, vitamin B12, folate and other essential nutrients. Deficiency in any of these nutrients means inadequate amounts of hemoglobin is being produced, leading to anemia [4].

Prevention

Some forms of anemia can be prevented. Those that occur due to iron and vitamin deficiency can easily be prevented by choosing a diet rich in these nutrients. Those who are vulnerable towards anemia, for eg; children and pregnant women should consider taking supplements. There are other forms of anemia which cannot be prevented. However, treatment should be initiated right when preliminary signs develop to prevent complications from setting in.

Summary

Anemia is characterized by decrease in the number of red blood cells or hemoglobin in the blood. In other words, when the blood loses its capacity to carry oxygen, the individual is known to have developed anemia. Individuals with anemia often complain of tiredness and weakness. Anemia is of several types, and all have different causative factors. It is a common occurrence and can affect individuals of any age group. If the condition is not treated on time, it can lead to serious and long term debilitating complications [1]. 

Patient Information

Definition

Anemia is a condition defined by significant reduction in hemoglobin levels, like below 12.5g/dL. In this condition, the body does not produce adequate red blood cells. Anemia is more prevalent in women and children. It has been estimated that about 1.5 billion individuals across the globe suffer from anemia.

Cause

Causes of anemia include blood loss due to trauma or other disease conditions and inadequate production or early destruction of red blood cells.

Symptoms

Individuals with anemia suffer from fatigue, weakness, headache, and lightheadedness, pale color of the skin, brittle nails and concentration problems.

Diagnosis

Diagnosis of anemia includes physical examination followed by blood tests to determine complete blood count. In addition, specialized tests to determine the size and shape of red blood cells would also be required.

Treatment

Anemia is treated through supplements and modification in diet. Many forms of anemia may require blood transfusions and bone marrow transplants.

References

Article

  1. Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood 2006; 107:1747.
  2. Young NS, Scheinberg P, Calado RT. Aplastic anemia. CurrOpinHematol. May 2008;15(3):162-8.
  3. Patel KV. Epidemiology of anemia in older adults.SeminHematol 2008; 45:210.
  4. Nutritional anaemias.Report of a WHO scientific group. World Health Organ Tech Rep Ser 1968; 405:5
  5. DeLoughery TG. Microcytic anemia. N Engl J Med. Oct 2 2014;371(14):1324-31.
  6. Means RT, Glader B. Anemia: General Considerations. In: Wintrobe's Clinical Hematology, 12 Ed, Greer JP, Foerster J, Rodgers GM, et al. (Eds), Lippincott Williams and Wilkins, Philadelphia 2009. Vol 1, p.784.
  7. Rapaport SI. Diagnosis of anemia. In: Introduction to hematology, JB Lippincott, Philadelphia 1987. p.15
  8. Kuku I, Kaya E, Yologlu S, Gokdeniz R, Baydin A. Platelet counts in adults with iron deficiency anemia.Platelets. Aug 3 2009;1-5.
  9. Mozaffari-Khosravi H, Noori-Shadkam M, Fatehi F, Naghiaee Y. Once weekly low-dose iron supplementation effectively improved iron status in adolescent girls. Biol Trace Elem Res. Aug 4 2009;epub ahead of print.
  10. Borgna-Pignatti C, Rugolotto S, De Stefano P, et al. Survival and complications in patients with thalassemia major treated with transfusion and deferoxamine. Haematologica. Oct 2004;89(10):1187-93.

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Last updated: 2017-08-09 18:21