Nutritional Deficiency Anemias
|
|
- Gerald Harmon
- 7 years ago
- Views:
Transcription
1 Nutritional Deficiency Anemias Darshan Mehta, MD Department of Internal Medicine University of Illinois-Chicago Anemia Definition Reduction in blood transport of oxygen due to a deficiency in red blood cells Parameters of Anemia Hematocrit Percentage of blood volume as RBCs Hemoglobin Concentration of hemoglobin in blood Mean Corpuscular Volume (MCV) Average size of RBC Mean Corpuscular Hemoglobin (MCH) Average hemoglobin content of RBC RDW range of deviation around average 1
2 Mechanisms of Anemia Marrow production defects (hypoproliferation) Low reticulocyte count Little or no change in red cell morphology (a normocytic, normochromic anemia Red cell maturation defects (ineffective erythropoiesis) Slight to moderately elevated reticulocyte count Macrocytic or microcytic anemia Decreased red cell survival (blood loss/ hemolysis). Classification of anemias by MCV Microcytic (<80 fl) Iron deficiency Thalassemia Anemia of chronic disease Macrocytic (>100 fl) Vitamin B12 deficiency Folate deficiency Myelodysplasia Chemotherapy Liver disease Increased reticulocytosis Myxedema Normocytic Anemia of chronic disease Aplasia Protein-energy malnutrition Chronic renal failure Post-hemorrhagic 2
3 Initial Evaluation History and Physical Exam Eating ice or clay Dyspnea Conjunctival pallor Chest Pain Medications Laboratory evaluation CBC with differential Peripheral Smear Reticulocyte count Iron Studies Nutrient Roles in Erythropoesis 3
4 Iron Stores Humans contain ~2.5 g of iron, with g circulating as part of heme in hemoglobin Another ~0.3 g found in myoglobin, in heme in cytochromes, and in Fe-S complexes Iron stored in body primarily as protein complexes (ferritin and hemosiderin) Nutritional Iron Balance Intake Dietary iron intake Medicinal iron Red cell transfusions Injection of iron complexes Excretion Gastrointestinal bleeding Menses Losses can be as much as 4-37mg/menstrual cycle Other forms of bleeding Loss of epidermal cells from the skin and gut 4
5 Iron Absorption Dietary iron content is closely related to total caloric intake (approximately 6 mg of elemental iron per 1000 calories) Iron bioavailability is affected by the nature of the foodstuff, with heme iron (e.g., red meat) being most readily absorbed Heme iron> Organic iron (Ferrous gluconate) > Inorganic iron (ferrous sulfate) Average iron intake in an adult male is 15 mg/d with 6% absorption; average female, the daily intake is 11 mg/d with 12% absorption Acid ph and presence of reducing agents: ascorbic acid (vitamin C) reduces Fe +++ to Fe ++ which promotes passage across intestinal mucosa Vegetarians are at an additional disadvantage because certain foodstuffs that include phytates and phosphates reduce iron absorption by about 50% Takes place in the mucosa of the proximal small intestine Absorption increase to 20% in iron-deficient persons Dietary Sources of Iron Red meat > poultry & fish In U.S., 20 mg iron added/lb of flour Baked bread contains ~28 mg iron/kg Equivalent to the iron content of beef Iron cooking pots Plants are generally not good sources because of oxalate, phytate, tannins, etc. Spinach has a lot of iron, but has ~780 mg oxalate/100 g Note - Heme iron absorption from diet not affected by ascorbate or phytate 5
6 Iron Exchange 80% of iron passing through the plasma transferrin pool is recycled from brokendown red cells Absorption of about 1 mg/d is required from the diet in men, 1.4 mg/d in women to maintain homeostasis Iron Deficiency Anemia Facts and Figures Most common cause of anemia 500 million cases worldwide Prevalence is higher in less developed countries Unique Physical Exam findings Cheilosis fissures at the corners of the mouth Koilonychia spooning of the fingernails 6
7 Causes of Iron Deficiency Increased demand for iron and/or hematopoiesis Rapid growth in infancy or adolescence Pregnancy Erythropoietin therapy Increased iron loss Chronic blood loss Menses Acute blood loss Blood donation Phlebotomy as treatment for polycythemia vera Decreased iron intake or absorption Inadequate diet Malabsorption from disease (sprue, Crohn's disease) Malabsorption from surgery (post-gastrectomy) Acute or chronic inflammation 7
8 Iron Deficiency Anemia Hypochromic red cell Microcytic cell Target cell Stages of Iron Deficiency 8
9 Treatment of Iron Deficiency Red Blood Cell Transfusion Oral Iron Therapy Ferrous sulfate Ferrous fumarate Ferrous gluconate Parenteral Iron Iron Supplementation in special populations Pregnant Women During the last two trimesters, daily iron requirements increase to 5 to 6 mg Infancy Normal-term infants are born with sufficient iron stores to prevent iron deficiency for the first 4 5 months of life Thereafter, enough iron needs to be absorbed to keep pace with the needs of rapid growth Nutritional iron deficiency is most common between 6 and 24 months of life 9
10 Megaloblastic Anemia Due to impaired DNA synthesis Affects cells primarily having relatively rapid turnover, especially hematopoietic precursors and gastrointestinal epithelial cells Cell division is sluggish, but cytoplasmic development progresses normally, so megaloblastic cells tend to be large, with an increased ratio of RNA to DNA. Megaloblastic erythroid progenitors tend to be destroyed in the marrow Marrow cellularity is often increased but production of red blood cells (RBC) is decreased Causes of Megaloblastic Anemia Vitamin B12 Deficiency Inadequate intake: vegans (rare) Malabsorption Defective release of cobalamin from food Gastric achlorhydria Partial gastrectomy Drugs that block acid secretion Inadequate production of intrinsic factor (IF) Pernicious anemia Total gastrectomy Disorders of terminal ileum Sprue Regional enteritis Intestinal resection Competition for cobalamin Fish tapeworm (Diphyllobothrium latum) Bacteria: "blind loop" syndrome Drugs: p-aminosalicylic acid, colchicine, neomycin 10
11 Clinical Manifestations of Vitamin B12 Deficiency Hematologic Macrocytic Anemia Gastrointestinal Glossitis Anorexia Diarrhea Neurologic (found in 3/4 th of individuals with pernicious anemia) Numbness and paresthesia in the extremities, Weakness, Ataxia Sphincter disturbances Disturbances of mentation Mild irritability and forgetfulness to severe dementia or frank psychosis. Demyelination, Axonal degeneration, and then Neuronal death Last stage is irreversible Megaloblastic Anemia Macrocytic RBC Hypersegmented Neutrophil 11
12 Vitamin B12 Absorption Oral Phase Vitamin B12 Absorption Gastric Phase 12
13 Vitamin B12 Absorption Intestinal Phase Vitamin B12 Deficiency Any interruption along this path can result in cobalamin deficiency Gastrectomy results in low production of IF Terminal ileal resection (>100 cm), decreases the site of absorption of B12-IF complex 13
14 Pernicious Anemia Most common cause of cobalamin deficiency Caused by the absence of IF Atrophy of the mucosa Autoimmune destruction of parietal cells Seen in individuals of northern European descent and African Americans Men and women are equally affected Disease of the elderly, the average patient presenting near age 60 Diagnosis of Vitamin B12 Deficiency Macrocytosis Peripheral blood smear Cobalamin levels Elevated serum methylmalonic acid and homocysteine levels Schilling Test 14
15 Schilling Test Measures B12 deficiency Detects IF deficiency Detects abnormal results in patients with genetic defects in B12 absorption, bacterial overgrowth of the small bowel, resection/bypass of terminal ileum, and pancreatic insufficiency Stage 1 Oral dose of radiolabeled cobalamin given simultaneously with an IM injection unlabeled cobalamin 24 Hour Urine collection Amount radiolabeled activity is measured Normal absorption of B12 and normal renal function will excrete > 7% of radiolabeled B12 15
16 Stage 2 If stage 1 is abnormal, then test is repeated following 60 mg of oral IF If the level of urinary radiolabeled B12 normalizes, then this indicates pernicious anemia Stage 3 Small intestine bacterial overgrowth may cause B12 malabsorption and an abnormal result in stage 1 that is not corrected with IF administration in stage 2 Broad spectrum antibiotics are given for one week to eliminate intestinal bacteria and then stage 1 should normalize 16
17 Stage 4 If pancreatic insufficiency exists, B12 malabsorption may occur Normalization after pancreatic enzyme therapy suggests pancreatic origin Causes of Megaloblastic Anemia Folate Deficiency Inadequate intake: unbalanced diet (common in alcoholics, teenagers, some infants) Increased requirements Pregnancy Infancy Malignancy Increased hematopoiesis (chronic hemolytic anemias) Chronic exfoliative skin disorders Hemodialysis Malabsorption Sprue Drugs: Phenytoin, barbiturates, (?) ethanol Impaired metabolism Inhibitors of dihydrofolate reductase: methotrexate, pyrimethamine, triamterene, pentamidine, trimethoprim Alcohol Rare enzyme deficiencies: dihydrofolate reductase, others 17
18 Treatment of Vitamin B12 Deficiency Replacement therapy Parenteral treatment given weekly intramuscularly for 8 weeks, followed by intramuscularly every month for the rest of the patient's life. Daily oral replacement therapy Folate Deficiency More often malnourished than those with cobalamin deficiency Gastrointestinal manifestations More widespread and more severe than those of pernicious anemia Diarrhea is often present Cheilosis Glossitis Neurologic abnormalities do not occur 18
19 Stages of folate deficiency 1. Negative folate balance (decreased serum folate) 2. Decreased RBC folate levels and hypersegmented neutrophils 3. Macroovalocytes, increased MCV, and decreased hemoglobin Diagnosis of folate deficiency Peripheral blood and bone marrow biopsy look exactly like B12 deficiency Plasma folate <3 ng/ml fluctuates with recent dietary intake RBC folate more reliable of tissue stores <140 ng/ml Only increased serum homocysteine levels but NOT serum methylmalonic acid levels 19
20 Treatment of folate deficiency Oral replacement therapy Folate prophylaxis Women planning pregnancy are advised to take 400 g folic acid daily before conception and until 12 weeks of pregnancy to prevent neural-tube defects (5 mg/day for women with a previous affected pregnancy) Folate fortification of cereal grains at 1 4 mg/kg has been made mandatory in the USA as an additional method of improving the folate status of the population. Prophylactic folate is also recommended in other states of increased demand such as long-term hemodialysis and chronic haemolytic disorders Inappropriate Treatment of Pernicious Anemia With Folate Vitamin B 12 deficiency anemia can be temporarily corrected by folate supplementation However, this does not correct the neurologic deficits Folate draws vitamin B 12 away from neurologic system for RBC production and can exacerbate combined systems degeneration 20
IRON METABOLISM DISORDERS
IRON METABOLISM DISORDERS ANEMIA Definition Decrease in the number of circulating red blood cells Most common hematologic disorder by Most common hematologic disorder by far 1 Blood loss ANEMIA Causes
More informationHow to evaluate vitamin and iron deficiency in practice?
How to evaluate vitamin and iron deficiency in practice? Y Beguin University of Liège Belgium COI DECLARATION Advisory board : Vifor, Pharmacosmos, Amgen Speakers bureau : Vifor, Amgen Consultant : Amgen,
More informationGuidelines for the Investigation and Management of Vitamin B12 and Folate Deficiency
Hull and East Riding Prescribing Committee Guidelines for the Investigation and Management of Vitamin B12 and Folate Deficiency Developed by:, Hull & East Yorkshire Hospital NHS Trust Hull and East Riding
More informationLaboratory Studies in the Diagnosis of Iron Deficiency, Latent Iron Deficiency and Iron Deficient Erythropoiesis
Laboratory Studies in the Diagnosis of Iron Deficiency, Latent Iron Deficiency and Iron Deficient Erythropoiesis General Comments The laboratory studies listed below are helpful in the diagnosis and management
More informationInformation for Clinicians
Information for Clinicians Guidelines for the Investigation & Management of vitamin B12 deficiency Background We frequently get asked for advice on the cause of a patient s vitamin B12 (cobalamin) deficiency
More information45813E/Revised: April 2008 CYANOCOBALAMIN INJECTION, USP
45813E/Revised: April 2008 CYANOCOBALAMIN INJECTION, USP DESCRIPTION: Cyanocobalamin Injection, USP is a sterile solution of cyanocobalamin for intramuscular or subcutaneous use. Each ml contains 1000
More informationB12 & Cobalamin. Learning objectives
Learning objectives B12 & Cobalamin Define vitamins Classify fat soluble and water soluble vitamins. Study chemical structure and biological active coenzyme form of vitamin B12. List the dietary sources
More informationDESCRIPTION CLINICAL PHARMACOLOGY. Nascobal (Cyanocobalamin, USP) Nasal Spray 500 mcg/spray 0.125 ml Rx only
Nascobal (Cyanocobalamin, USP) Nasal Spray 500 mcg/spray 0.125 ml Rx only DESCRIPTION Cyanocobalamin is a synthetic form of vitamin B 12 with equivalent vitamin B 12 activity. The chemical name is 5,6-dimethyl-benzimidazolyl
More informationNHS FORTH VALLEY B12 and Folate: A Practical Guide
NHS FORTH VALLEY B12 and Folate: A Practical Guide Date of First Issue 27/05/2011 Approved 28/06/2011 Current Issue Date 24/06/2013 Review Date 24/06/2015 Version 1.0 EQIA 27/05/2011 Author / Contact Group
More informationWATER SOLUBLE VITAMINS
WATER SOLUBLE VITAMINS BY: SHAMSUL AZAHARI ZAINAL BADARI DEPARTMENT OF RESOURCES MANAGEMENT AND CONSUMER STUDIES FACULTY OF HUMAN ECOLOGI UNIVERSITI PUTRA MALAYSIA WATER SOLUBLE VITAMINS Include vitamin
More informationCollect and label sample according to standard protocols. Gently invert tube 8-10 times immediately after draw. DO NOT SHAKE. Do not centrifuge.
Complete Blood Count CPT Code: CBC with Differential: 85025 CBC without Differential: 85027 Order Code: CBC with Differential: C915 Includes: White blood cell, Red blood cell, Hematocrit, Hemoglobin, MCV,
More informationVitamin B12 1200 mcg Timed Release Tablets
Vitamin B12 1200 mcg Timed Release Tablets Product Summary: Vitamin B12 (cyanocobalamin) is a water soluble vitamin necessary for energy production; for nervous system function as it is needed to produce
More informationVitamin B12 (cobalamin) plays
Vitamin B 12 Deficiency ROBERT C OH, CPT, MC, USA, US Army Health Clinic, Darmstadt, Germany DAVID L BROWN, MAJ, MC, USA, Madigan Army Medical Center, Fort Lewis, Washington Vitamin B 12 (cobalamin) deficiency
More informationNutritional Challenges After Surgery
Nutritional Challenges After Surgery L I N D A P A T A K I M S R D C S O L D C N S C M D A N D E R S O N C A N C E R C E N T E R H O U S T O N, T E X A S Objectives Identify the reasons that GIST and its
More informationAnemia: Nutritional Deficiencies. Alison R. Moliterno MD JHUSOM July 2012
Anemia: Nutritional Deficiencies Alison R. Moliterno MD JHUSOM July 2012 A 44 yo social worker is referred to you for anemia. She is married, with teenage children, and has no history of bleeding, and
More informationScreening for Iron Deficiency
Article hematology Screening for Iron Deficiency Ann Chen Wu, MD,* Leann Lesperance, MD, PhD,* Henry Bernstein, DO* Objectives After completing this article, readers should be able to: 1. Determine the
More informationOverview. Nutritional Aspects of Primary Biliary Cirrhosis. How does the liver affect nutritional status?
Overview Nutritional Aspects of Primary Biliary Cirrhosis Tracy Burch, RD, CNSD Kovler Organ Transplant Center Northwestern Memorial Hospital Importance of nutrition therapy in PBC Incidence and pertinence
More informationSchool-age child 5-1 THE BLOOD
C A S E S T U D Y 5 : School-age child Adapted from Thomson Delmar Learning s Case Study Series: Pediatrics, by Bonita E. Broyles, RN, BSN, MA, PhD. Copyright 2006 Thomson Delmar Learning, Clifton Park,
More informationMANAGING ANEMIA. When You Have Kidney Disease or Kidney Failure. www.kidney.org
MANAGING ANEMIA When You Have Kidney Disease or Kidney Failure www.kidney.org About the Information in this Booklet Did you know that the National Kidney Foundation (NKF) offers guidelines and commentaries
More informationBlood Testing Protocols. Disclaimer
Blood Testing Protocols / Page 2 Blood Testing Protocols Here are the specific test protocols recommend by Dr. J.E. Williams. You may request these from your doctor or visit www.readyourbloodtest.com to
More informationAdams Memorial Hospital Decatur, Indiana EXPLANATION OF LABORATORY TESTS
Adams Memorial Hospital Decatur, Indiana EXPLANATION OF LABORATORY TESTS Your health is important to us! The test descriptions listed below are for educational purposes only. Laboratory test interpretation
More informationA] Calcium. Absorption is interfered with by: Phytic acid of cereal seeds and bran. Oxalic acid and soluble oxalates of some vegetables and fruits.
Food Constituents [continued] 6- Essential elements Diet provides a number of inorganic elements that are needed for: Normal functioning of vital processes of the body. Formation and maintenance of bone
More informationSaskatchewan Drug Information Services College of Pharmacy and Nutrition, U of S T: (306)966-6340 F:(306)966-2286 www.usask.
Saskatchewan Drug Information Services College of Pharmacy and Nutrition, U of S T: (306)966-6340 F:(306)966-2286 www.usask.ca/druginfo Volume 19, Issue No. 2 March-April, 2002 TO P.O. B 12 OR NOT TO P.O.
More informationPACKAGE LEAFLET: INFORMATION FOR THE USER. VITAMINE B12 STEROP 1mg/1ml Solution for injection / oral solution. Cyanocobalamin
PACKAGE LEAFLET: INFORMATION FOR THE USER VITAMINE B12 STEROP 1mg/1ml Solution for injection / oral solution Cyanocobalamin Read all of this leaflet carefully before you start using this medicine because
More informationHematology Morphology Critique
Survey Slide: History: 60-year-old female presenting with pneumonia Further Laboratory Data: Hgb : 90 g/l RBC : 2.92 10 12 /L Hct : 0.25 L/L MCV : 87 fl MCH : 30.8 pg MCHC : 355 g/l RDW : 17.7 % WBC :
More informationConclusions of a WHO Technical Consultation on folate and vitamin B 12 deficiencies
Conclusions of a WHO Technical Consultation on folate and vitamin deficiencies Key words: Folate, vitamin Preamble Folate and vitamin deficiencies occur primarily as a result of insufficient dietary intake
More informationVitamins & Minerals Associated with Metabolism & Blood Health
Vitamins & Minerals Associated with Metabolism & Blood Health Metabolism B-complex vitamins are especially important for energy metabolism thiamin (B 1 ) folate riboflavin (B 2 ) vitamin B 12 niacin pantothenic
More informationYoung fetus: site of hematopoiesis together with the liver and bone marrow. Hgb WBC >----------< Plt Hct. Retic =
Learning Objectives At the completion of this program, the participants will be able to: 1. Identify the components of the CBC and Differential and their clinical implications. 2. Identify normal pediatric
More informationICD-9-CM/ICD-10-CM Codes for MNT
/ Codes for MNT ICD (International Classification of Diseases) codes are used by physicians and medical coders to assign medical diagnoses to individual patients. It is not within the scope of practice
More informationRole and Importance of Vitamin B12
Role and Importance of Vitamin B12 Fred Hardinge, DrPH, RD Associate Health Ministries Director General Conference of Seventh-day Adventists 1 Essential Functions Red blood cell formation. Neurological
More informationLiver, Gallbladder, Exocrine Pancreas KNH 406
Liver, Gallbladder, Exocrine Pancreas KNH 406 2007 Thomson - Wadsworth LIVER Anatomy - functions With disease blood flow becomes obstructed Bile All bile drains into common hepatic duct Liver Bile complex
More informationAnemia and Iron Deficiency. Sean Lynch Professor of Clinical Medicine Eastern Virginia Medical School
Anemia and Iron Deficiency Sean Lynch Professor of Clinical Medicine Eastern Virginia Medical School Progress towards eliminating nutritional iron deficiency Careful evaluation, compilation and application
More informationChapter 9 IRON DEFICIENCY ANEMIA
Chapter 9 IRON DEFICIENCY ANEMIA Irene Alton Iron deficiency is the most prevalent nutritional deficiency and the most common cause of anemia in the United States. 1 Iron deficiency anemia is characterized
More informationWhy iron and haemoglobin are important
Iron and haemoglobin Why iron and haemoglobin are important Meet Kylie Kylie is a blood donor. Kylie knows that having a healthy iron enriched diet will help restore the iron removed with blood donation.
More informationSTAINING OF PBF AND INTERPRETATION OF NORMAL AND ABNORMAL RED CELL MORPHOLOGY
9 STAINING OF PBF AND INTERPRETATION OF NORMAL AND ABNORMAL RED CELL MORPHOLOGY 9.1 INTRODUCTION A peripheral blood smear (peripheral blood film) is a glass microscope slide coated on one side with a thin
More informationManaging Anemia When You Are on Dialysis. Stage 5
Managing Anemia When You Are on Dialysis Stage 5 What is anemia? Anemia happens when your red blood cells are in short supply. Red blood cells carry oxygen from your lungs to all parts of your body, giving
More informationRDW-- Interpreting the Full Blood Count
RDW-- Interpreting the Full Blood Count The most important components of a Full Blood Count report are, of course, the Haemoglobin, the White Cell Count and Differential and the Platelet Count. However,
More informationProceeding of the ACVP/ASVCP Concurrent Annual Meetings
http://www.ivis.org Proceeding of the ACVP/ASVCP Concurrent Annual Meetings Dec.3-7, 2011 Nashville, Tennessee, USA Next Meeting : December 1-5, 2012 - Seattle, WA, USA Reprinted in the IVIS website with
More informationAnemia and chronic kidney disease
Anemia and chronic kidney disease THE KIDNEY FOUNDATION OF CANADA 1 Anemia and chronic kidney disease What is anemia? Anemia is a condition in which the red cells in the blood are at a low level. The red
More informationWhy are Vitamin and Mineral Supplements so Important Before and after Bariatric Surgery? 6/4/2014 1
Why are Vitamin and Mineral Supplements so Important Before and after Bariatric Surgery? 6/4/2014 1 All About Vitamins Reminder for those in Pre-Surgery or Supervised Weight Loss Program 1. Liver reduction
More informationThe B-Vitamins: Folate and B12. Peripheral Smear. Megaloblastic Anemia. Hypochromic Microcytosis. History. Folate. Saurabh Mehta, M.B.B.S., Sc.D.
The B-Vitamins: and Saurabh Mehta, M.B.B.S., Sc.D. Assistant Professor of Global Health and Nutrition Division of Nutritional Sciences Cornell University September 22, 2011 Peripheral Smear http://library.med.utah.edu/
More informationSiderAL is a Trademark owned by FOR THE TREATMENT OF ALL IRON DEFICIENCY RELATED ANEMIAS
SiderAL is a Trademark owned by FOR THE TREATMENT OF ALL IRON DEFICIENCY RELATED ANEMIAS IRON AND ITS FUNCTIONS Iron is an essential element for living cells, given its ability to gain and lose electrons.
More informationWhat Does My Bone Marrow Do?
What Does My Bone Marrow Do? the myelodysplastic syndromes foundation, inc. Illustrations by Kirk Moldoff Published by The Myelodysplastic Syndromes Foundation, Inc. First Edition, 2009. 2012. Table of
More informationLocal Coverage Determination (LCD): Vitamin B 12 Injection (L33502)
Local Coverage Determination (LCD): Vitamin B 12 Injection (L33502) Contractor Name Noridian Administrative Services, LLC LCD Information Document Information LCD ID L33502 LCD Title Vitamin B 12 Injection
More informationInterpretation of Laboratory Values
Interpretation of Laboratory Values Konrad J. Dias PT, DPT, CCS Overview Electrolyte imbalances Renal Function Tests Complete Blood Count Coagulation Profile Fluid imbalance Sodium Electrolyte Imbalances
More informationYvette Marie Miller, M.D. Executive Medical Officer American Red Cross October 20, 2012 45 th Annual Great Lakes Cancer Nursing Conference Troy, MI
Yvette Marie Miller, M.D. Executive Medical Officer American Red Cross October 20, 2012 45 th Annual Great Lakes Cancer Nursing Conference Troy, MI Overview of Hematology, http://www.nu.edu.sa/userfiles/mhmorsy/h
More informationWithout intrinsic factor, which is a unique protein made in the stomach, vitamin B12 cannot gain access to the rest of the body where it is needed.
What is vitamin B12? Vitamin B12 is one of the most controversial members of the vitamin family collectively referred to as the "B-complex" vitamins. Although the full chemical structure of B12 was not
More informationDietary Fiber and Alcohol. Nana Gletsu Miller, PhD Spring 2014
Dietary Fiber and Alcohol Nana Gletsu Miller, PhD Spring 2014 Dietary Fiber It is the complex carbohydrate in plants that can not be broken down by human digestive enzymes Sources Grains Fruits and Vegetables
More informationItem 6 of the Agenda. Symposium on. Pan American Health Organization ADVISORY COMMITTEE ON MEDICAL RESEARCH. Eighth Meeting
Pan American Health Organization ADVISORY COMMITTEE ON MEDICAL RESEARCH Eighth Meeting Washington, D.C., 9-13 June 1969 Item 6 of the Agenda Symposium on IRON METABOLISM AND ANEMIA (Abstracts of Papers)
More informationWhat are Minerals. Lecture 13: Minerals. Trace versus Major Minerals. Minerals are elements, can be found on the periodic table
Lecture 13: Minerals What are Minerals Minerals are elements, can be found on the periodic table Inorganic (in chemical sense) Nutrition 150 Shallin Busch, Ph.D. Not broken down during digestion nor destroyed
More informationINITIATING ORAL AUBAGIO (teriflunomide) THERAPY
FOR YOUR PATIENTS WITH RELAPSING FORMS OF MS INITIATING ORAL AUBAGIO (teriflunomide) THERAPY WARNING: HEPATOTOXICITY AND RISK OF TERATOGENICITY Severe liver injury including fatal liver failure has been
More informationHow To Get Healthy
Dietary Fiber and Alcohol Nana Gletsu Miller, PhD Fall 2-13 Dietary Fiber It is the complex carbohydrate in plants that can not be broken down by human digestive enzymes Sources Grains Fruits and Vegetables
More informationBlood & Marrow Transplant Glossary. Pediatric Blood and Marrow Transplant Program Patient Guide
Blood & Marrow Transplant Glossary Pediatric Blood and Marrow Transplant Program Patient Guide Glossary Absolute Neutrophil Count (ANC) -- Also called "absolute granulocyte count" amount of white blood
More informationAt one time, the diagnosis of a deficiency of vitamin B12 or folate was considered to
REVIEW ARTICLE Laboratory Diagnosis of Vitamin B 12 and Folate Deficiency A Guide for the Primary Care Physician Christopher F. Snow, MD At one time, the diagnosis of a deficiency of vitamin B12 or folate
More informationGP Guidance: Management of nutrition following bariatric surgery
GP Guidance: Management of nutrition following bariatric surgery Introduction Patients who are morbidly obese will have struggled with their weight for many years before going forward for bariatric surgery.
More informationPERINATAL NUTRITION. Nutrition during pregnancy and lactation. Nutrition during infancy.
PERINATAL NUTRITION Nutrition during pregnancy and lactation Nutrition during infancy. Rama Bhat, MD. Department of Pediatrics, University of Illinois Hospital Chicago, Illinois. Nutrition During Pregnancy
More informationIron Deficiency Anaemia
CHAPTER 1 Iron Deficiency Anaemia Drew Provan OVERVIEW Iron deficiency is the commonest cause of anaemia worldwide Iron deficiency is usually easily diagnosed from the red cell indices A drop in haemoglobin
More informationRecommendations to Prevent and Control Iron Deficiency in the United States
April 3, 1998 / Vol. 47 / No. RR-3 TM Recommendations and Reports Recommendations to Prevent and Control Iron Deficiency in the United States U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease
More informationComparison of Nutritional Deficiencies after Rouxen-Y Gastric Bypass and after Biliopancreatic Diversion with Roux-en-Y Gastric Bypass
Obesity Surgery, 12, 551-558 Comparison of Nutritional Deficiencies after Rouxen-Y Gastric Bypass and after Biliopancreatic Diversion with Roux-en-Y Gastric Bypass George Skroubis, MD 1 ; George Sakellaropoulos,
More informationNutritional Support of the Burn Patient
Nutritional Support of the Burn Patient Objectives To understand the principles of normal nutrient utilization and the abnormalities caused by burn injury To be able to assess nutrient needs To be able
More informationVisual Acuity. Hearing. Height and Weight. Blood Pressure MEASURED VALUE
TEST ITEM DESCRIPTION STANDARD LEVEL Standard level varies among different examination methods. Please check with your medical facility about normal level. MEASURED VALUE Visual Acuity You look at rings
More informationThibodeau: Anatomy and Physiology, 5/e. Chapter 17: Blood
Thibodeau: Anatomy and Physiology, 5/e Chapter 17: Blood This chapter begins a new unit. In this unit, the first four chapters deal with transportation one of the body's vital functions. It is important
More informationchronic leukemia lymphoma myeloma differentiated 14 September 1999 Pre- Transformed Ig Surface Surface Secreted Myeloma Major malignant counterpart
Disease Usual phenotype acute leukemia precursor chronic leukemia lymphoma myeloma differentiated Pre- B-cell B-cell Transformed B-cell Plasma cell Ig Surface Surface Secreted Major malignant counterpart
More informationCa : methods for determining DRIs. Adults. 4average requirement, meta-analyzed balance studies by FAO/WHO :
Minerals Categories of Ds for Minerals - Ca, P, Na, Cl, K, Mg - Mineral Ca RDA P Ca ; 서울대학교 이연숙 Na P ; 국민대학교 김선희 Na, Cl ; 동의대학교 임화재 K ; 국민대학교 장문정 Mg ; 인하대학교 천종희 Cl K Mg Indicators for Estimating Ds Ca
More informationChemistry. All the three compounds are Naphthoquinone derivatives
VITAMIN K History Existence first suggested by Henrik Dam in 1929 - Observed : Hemorrhagic disease of cattle fed on synthetic diets 1939 : Dam & co-workers isolated Vitamin K from the plant Alfalfa Edward
More informationEXECUTIVE BLOOD WORK PANEL
EXECUTIVE BLOOD WORK PANEL Below is a list of all blood and urine testing done on the day of your Executive Medical. MALE Serum Glucose Random Serum Glucose Fasting Creatinine Uric Acid Sodium Potassium
More informationA.L. Wafa a sameer 2014 Circulatory system / Physiology. Physiology of blood
Red Blood Cells (Erythrocytes) Physiology of blood E rythrocytes : are the most abundant cells of the blood and are necessary for the delivery of oxygen to the tissues. The major function of red blood
More informationHepatitis C. Laboratory Tests and Hepatitis C
Hepatitis C Laboratory Tests and Hepatitis C If you have hepatitis C, your doctor will use laboratory tests to check your health. This handout will help you understand what the major tests are and what
More informationProteins. Protein Trivia. Optimizing electrophoresis
Proteins ELECTROPHORESIS Separation of a charged particle in an electric field Michael A. Pesce, Ph.D Department of Pathology New York-Presbyterian Hospital Columbia University Medical Center Rate of migration
More informationNHRMC General Surgery Specialists. Minimally Invasive Gastrointestinal Surgery Phone: 910-662-9300 Fax: 910-662-9303
Minimally Invasive Gastrointestinal Surgery Phone: 910-662-9300 Fax: 910-662-9303 W. Borden Hooks III, MD 1725 New Hanover Medical Park Drive Wilmington, NC 28403 Thank you for choosing NHRMC General Surgery
More informationINTRODUCTION Thrombophilia deep vein thrombosis DVT pulmonary embolism PE inherited thrombophilia
INTRODUCTION Thrombophilia (Hypercoagulability) is a condition in which a person forms blood clots more than normal. Blood clots may occur in the arms or legs (e.g., deep vein thrombosis DVT), the lungs
More informationNutrient Reference Values for Australia and New Zealand
Nutrient Reference Values for Australia and New Zealand Questions and Answers 1. What are Nutrient Reference Values? The Nutrient Reference Values outline the levels of intake of essential nutrients considered,
More informationFolate intake in the European population. I. Elmadfa Institute of Nutritional Sciences, University of Vienna
Folate Status of the Population in the EC and Strategies for Change Expert Discussion Forum, 11/12 Jannuary 2007, BfR,, Berlin, Germany Folate intake in the European population I. Elmadfa Institute of
More informationTuberculosis And Diabetes. Dr. hanan abuelrus Prof.of internal medicine Assiut University
Tuberculosis And Diabetes Dr. hanan abuelrus Prof.of internal medicine Assiut University TUBERCULOSIS FACTS More than 9 million people fall sick with tuberculosis (TB) every year. Over 1.5 million die
More informationDietary Reference Intakes: Vitamins
Biotin Coenzyme in synthesis of fat, glycogen, and amino acids Liver and smaller b amounts in fruits and 6* meats 8* 12* 20* 2 of biotin in humans or animals were found. This does not mean biotin are limited,
More informationMedical Nutrition Therapy for Upper Gastrointestinal Tract Disorders. By: Jalal Hejazi PhD, MSc.
Medical Nutrition Therapy for Upper Gastrointestinal Tract Disorders By: Jalal Hejazi PhD, MSc. Digestive Disorders Common problem; more than 50 million outpatient visits per year Dietary habits and nutrition
More informationLong Term Use of Antacid Medications Can Cause an Increased Risk for Osteoporosis and Much More
Long Term Use of Antacid Medications Can Cause an Increased Risk for Osteoporosis and Much More By: Jeremie Pederson D.C., C.S.C.S. Many people are concerned about the FDA news release dated May 25, 2010
More informationCauses of vitamin B 12 and folate deficiency
Causes of vitamin and folate deficiency Lindsay H. Allen Key words: Deficiency, folate, vitamin Abstract This review describes current knowledge of the main causes of vitamin and folate deficiency. The
More informationMALE AND FEMALE PANEL CHARTS
MALE AND FEMALE PANEL CHARTS Complete Blood Count (CBC) Test What this test measures What test results may indicate Red blood cell count Total number of red blood cells Blood loss High altitude per volume
More informationICD-10 CM/PCS Tip Sheets. Oncology
ICD-10 CM/PCS Tip Sheets Oncology About This Guide This collection of tip sheets has been developed by Cape Fear Valley Health to promote greater specificity of the coded data for a given condition, disease,
More informationEFFECT OF DAILY VERSUS WEEKLY IRON FOLIC ACID SUPPLEMENTATION ON THE HAEMOGLOBIN LEVELS OF CHILDREN 6 TO 36 MONTHS OF URBAN SLUMS OF VADODARA
ORIGINAL ARTICLE. EFFECT OF DAILY VERSUS WEEKLY IRON FOLIC ACID SUPPLEMENTATION ON THE HAEMOGLOBIN LEVELS OF CHILDREN 6 TO 36 MONTHS OF URBAN SLUMS OF VADODARA K Sharma 1, P Parikh 2, F Desai 3 1 PhD Advisor,
More informationBile Duct Diseases and Problems
Bile Duct Diseases and Problems Introduction A bile duct is a tube that carries bile between the liver and gallbladder and the intestine. Bile is a substance made by the liver that helps with digestion.
More informationCalcium. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com nuf40101 Last reviewed: 02/19/2013 1
Calcium Introduction Calcium is a mineral found in many foods. The body needs calcium to maintain strong bones and to carry out many important functions. Not having enough calcium can cause many health
More informationHemochromatosis. National Digestive Diseases Information Clearinghouse
Hemochromatosis National Digestive Diseases Information Clearinghouse What is hemochromatosis? Hemochromatosis is the most common form of iron overload disease. Too much iron in the body causes hemochromatosis.
More informationKEY CHAPTER 14: BLOOD OBJECTIVES. 1. Describe blood according to its tissue type and major functions.
KEY CHAPTER 14: BLOOD OBJECTIVES 1. Describe blood according to its tissue type and major functions. TISSUE TYPE? MAJOR FUNCTIONS connective Transport Maintenance of body temperature 2. Define the term
More informationMEDICATION GUIDE. PROCRIT (PRO KRIT) (epoetin alfa)
MEDICATION GUIDE PROCRIT (PROKRIT) (epoetin alfa) Read this Medication Guide: before you start PROCRIT. if you are told by your healthcare provider that there is new information about PROCRIT. if you are
More informationNORD Guides for Physicians #1. Physician s Guide to. Tyrosinemia. Type 1
NORD Guides for Physicians #1 The National Organization for Rare Disorders Physician s Guide to Tyrosinemia Type 1 The original version of this booklet was made possible by donations in honor of Danielle
More informationTHE VITAMIN B12 CONNECTION
THE VITAMIN B12 CONNECTION Overall health is the result of many different factors. Diet, lifestyle, genetics and the environment all contribute to the state of our well-being. Although it is difficult
More informationFACTS ON LIFE STYLE DISEASES AND NUTRITION DEFICIENCY DISEASES
FACTS ON LIFE STYLE DISEASES AND NUTRITION DEFICIENCY DISEASES INTRODUCTION We suffer from these diseases as a result of the way we live. Many are caused by Malnutrition. Malnutrition describes a partial
More informationUNDERSTANDING MULTIPLE MYELOMA AND LABORATORY VALUES Benjamin Parsons, DO bmparson@gundersenhealth.org Gundersen Health System Center for Cancer and
UNDERSTANDING MULTIPLE MYELOMA AND LABORATORY VALUES Benjamin Parsons, DO bmparson@gundersenhealth.org Gundersen Health System Center for Cancer and Blood Disorders La Crosse, WI UNDERSTANDING MULTIPLE
More informationEFFECTS OF IRON ON THE IMMUNE SYSTEM
EFFECTS OF IRON ON THE IMMUNE SYSTEM Gert Mayer Department of Internal Medicine IV (Nephrology and Hypertension) Medical University Innsbruck Austria Conflicts of interest Research Support: Amgen, Roche,
More informationBMJ 2014;349:g5226 doi: 10.1136/bmj.g5226 (Published 4 September 2014) Page 1 of 10
BMJ 2014;349:g5226 doi: 10.1136/bmj.g5226 (Published 4 September 2014) Page 1 of 10 Clinical Review Vitamin Alesia Hunt haematology specialist registrar, Dominic Harrington consultant clinical scientist,
More informationRecommended Dietary Allowances for Ireland 1999
Recommended Dietary Allowances for Ireland 1999 Published by: Food Safety Authority of Ireland Abbey Court Lower Abbey Street Dublin 1 Tel: 8171 300, Fax: 8171 301 Email: info@fsai.ie Website: www.fsai.ie
More informationIron deficiency in infants and young children: Screening, prevention, clinical manifestations, and diagnosis
Official reprint from UpToDate www.uptodate.com 2015 UpToDate Iron deficiency in infants and young children: Screening, prevention, clinical manifestations, and diagnosis Author Donald H Mahoney, Jr, MD
More informationCalcium Folinate Ebewe Data Sheet
NAME OF THE MEDICINE Calcium folinate injection Composition Active: Calcium folinate (equivalent to 10 mg folinic acid per ml) Inactive: Sodium chloride (7.7mg/mL), qs Water for Injections. Preservative
More informationUrinalysis and Body Fluids CRg. Chemical Exam of Urine - bilirubin. Chemical Exam of Urine - bilirubin. Unit 3. Chemical Examination of Urine
Urinalysis and Body Fluids CRg Unit 3 Chemical Examination of Urine Part 5, Bilirubin and Urobilinogen Chemical Exam of Urine - bilirubin Bilirubin and Urobilinogen - presence in urine may be the 1st indication
More informationApproach to Abnormal Liver Tests
Approach to Abnormal Liver Tests Naga P. Chalasani, MD, FACG Professor of Medicine and Cellular & Integrative Physiology Director, Division of Gastroenterology and Hepatology Indiana University School
More informationMultiple Myeloma. This reference summary will help you understand multiple myeloma and its treatment options.
Multiple Myeloma Introduction Multiple myeloma is a type of cancer that affects white blood cells. Each year, thousands of people find out that they have multiple myeloma. This reference summary will help
More informationINTRODUCTION Thrombophilia deep vein thrombosis DVT pulmonary embolism PE inherited thrombophilia
INTRODUCTION Thrombophilia (Hypercoagulability) is a condition in which a person forms blood clots more than normal. Blood clots may occur in the arms or legs (e.g., deep vein thrombosis DVT), the lungs
More informationThe Under-Recognized Role of Essential Nutrients in Health and Health Care
The Under-Recognized Role of Essential Nutrients in Health and Health Care Honolulu Subarea Health Planning Council February 7, 2013 Joannie Dobbs, Ph.D. CNS Assistant Specialist Human Nutrition, Food
More information