Nutritional anemia is caused by a lack of iron, protein, B12, and other vitamins and minerals that needed for the formation of hemoglobin.
Folic acid deficiency is a common association of nutritional anemia and iron deficiency anemia is the most common nutritional disorder.
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Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues.
Having anemia can make you feel tired and weak.
There are many forms of anemia, each with its own cause.
Anemia can be temporary or long term, and it can range from mild to severe.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Nutritional anemia is caused by a lack of iron, protein, B12, and other vitamins and minerals that needed for the formation of hemoglobin.
Folic acid deficiency is a common association of nutritional anemia and iron deficiency anemia is the most common nutritional disorder.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues.
Having anemia can make you feel tired and weak.
There are many forms of anemia, each with its own cause.
Anemia can be temporary or long term, and it can range from mild to severe.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Anaemia: Symptoms, Types, Causes & Treatment
Anaemia is a lack of Hemoglobin and red blood cells in the body. Red blood cells and hemoglobin, the molecules in red blood cells that make them red, are important because they carry oxygen from the lungs to other body parts.
Oxygen is very important to us and our body parts. So It is very important to find and treat the cause of the anemia as well as the anemia itself. Might be you have no symptoms of Anemia.
Symptoms of Anaemia
Anemia signs and symptoms vary depending on the cause and severity of anemia. Depending on the causes of your anemia, you might have no symptoms.
You will be short of breath and feel tired, even when doing things you could usually do easily.
You may also have a fast or irregular heartbeat.
Have cold feet or hands.
Look pale.
Having fatigue.
Chest pain.
Feel dizzy or faint.
Having headaches.
Types of anemia
There are three types of anemia
Mild hemoglobin in the body is around 10 to 11 g / dL which is called mild anemia.
Moderate- Hemoglobin is 8 to 9 g / dL it is called moderate anemia.
Severe -Severe anemia hemoglobin is less than 8 g / dL. This is a serious condition, in which it is also the turn of blood transfusion according to the condition of the patient.
Different types of anemia have different causes. They include:
Iron deficiency
Iron deficiency occurs as a result of a deficiency in the mineral iron in your body. It requires the production of hemoglobin, the component of the red blood cell that transports oxygen to your organs. Anemia due to a lack of iron can cause a variety of factors, including:
The diet, particularly in infants, children, teenagers, vegans, and vegetarians
Certain medications, meals, and caffeinated beverages
Crohn’s disease, or if a part of your stomach or small intestine has been removed, donating blood Endurance training Pregnancy and breastfeeding use up iron in your body
Your menstrual cycle
Chronic slow bleeding, mainly from the gastrointestinal tract, is a prevalent reason
Vitamin deficiency
When you don’t get enough vitamin B12 and folate, this can happen. These two vitamins are needed for the production of red blood cells. The following factors might cause this form of anemia:
Vitamin B12 deficiency: If you eat little or no meat, you may be deficient in this vitamin. You may not receive enough folate if you overcook veggies or don’t consume enough of them.
When you don’t get enough vitamin B12, folate, or both, you get megaloblastic anemia.
When your body doesn’t absorb enough vitamin B12, you get pernicious anemia.
Medications, alcohol misuse, and intestinal illnesses such as tropical sprue are further causes of vitamin insufficiency.
Anemia of inflammation
When your body doesn’t have enough hormones to generate red blood cells, this happens. This form of anemia is caused by the following conditions:
Kidney disease has progressed to an advanced stage.
Hypothyroidism
Long-term disorders such as cancer, infection, lupus, diabetes.
Anemia is a very common and widespread disease which is commonly affect the youngster girls/ Pregnant and lactating mothers and Children's of growing age.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Iron Defeciency Anemia
1. Iron-deficiency anemia (or iron-deficiency anaemia) is a common anemia (low red blood cell
or hemoglobin levels) caused by insufficient dietary intake and absorption of iron, and/or iron
loss from bleeding which can originate from a range of sources such as the intestinal, uterine or
urinary tract.
Iron deficiency causes approximately half of all anemia cases worldwide, and affects women
more often than men. World estimates of iron deficiency occurrence are somewhat vague, but the
true number probably exceeds one billion people.[1]
This can result if:
The body does not make enough red blood cells
Bleeding causes loss of red blood cells more quickly than they can be replaced
The most significant cause of iron-deficiency anemia in third world children is parasitic worms:
hookworms, whipworms, and roundworms. Worms cause intestinal bleeding, which is not
always noticeable in faeces, and is especially damaging to growing children.[2]
Malaria,
hookworms and vitamin A deficiency contribute to anemia during pregnancy in most
underdeveloped countries.[3]
In women over 50 years old, the most common cause of iron-
deficiency anemia is chronic gastrointestinal bleeding from nonparasitic causes, such as gastric
ulcers, duodenal ulcers or gastrointestinal cancer.
Anemia is one result of advanced-stage iron deficiency. When the body has sufficient iron to
meet its needs (functional iron), the remainder is stored for later use in all cells, but mostly in the
bone marrow, liver, and spleen. These stores are called ferritin complexes and are part of the
human (and other animals) iron metabolism systems. Ferritin complexes in humans carry about
4500 iron atoms and form into 24 protein subunits of two different types.[4]
Signs and symptoms
Iron-deficiency anemia is characterized by the sign of pallor (reduced oxyhemoglobin in skin or
mucous membranes), and the symptoms of fatigue, lightheadedness, and weakness. None of the
symptoms (or any of the others below) are sensitive or specific. Pallor of mucous membranes
(primarily the conjunctiva) in children is the sign of anemia with best correlation to the actual
disease, but in a large study was found to be only 28% sensitive and 87% specific (with high
predictive value) in distinguishing children with anemia [hemoglobin (Hb) <11.0 g/dl] and 49%
sensitive and 79% specific in distinguishing severe anemia (Hb < 7.0 g/dl).[5]
Thus, this sign is
reasonably predictive when present, but not helpful when absent, as only one-third to one-half of
children who are anemic (depending on severity) will show pallor. Iron-deficiency must be
diagnosed by laboratory testing.
Because iron deficiency tends to develop slowly, adaptation occurs and the disease often goes
unrecognized for some time, even years; patients often adapt to the systemic effects that anaemia
causes.. In severe cases, dyspnea (trouble breathing) can occur. Unusual obsessive food cravings,
known as pica, may develop. Pagophagia or pica for ice has been suggested to be specific, but is
2. actually neither a specific or sensitive symptom, and is not helpful in diagnosis. When present, it
may (or may not) disappear with correction of iron-deficiency anemia.
Other symptoms and signs of iron-deficiency anemia include:
Anxiety often resulting in OCD-type compulsions and obsessions
Irritability or a low feeling
Angina
Constipation
Sleepiness
Tinnitus
Mouth ulcers
Palpitations
Hair loss
Fainting or feeling faint
Depression
Breathlessness
Twitching muscles
Pale yellow skin
Tingling, numbness, or burning sensations
Missed menstrual cycle
Slow social development
Glossitis (inflammation or infection of the tongue)
Angular cheilitis (inflammatory lesions at the mouth's corners)
Koilonychia (spoon-shaped nails) or nails that are weak or brittle
Poor appetite
Pruritus (itchiness)
Dysphagia due to formation of esophageal webs (Plummer-Vinson syndrome)
Insomnia
Restless legs syndrome[6]
Infant development
Iron-deficiency anemia for infants in their earlier stages of development may have greater
consequences than it does for adults. An infant made severely iron-deficient during its earlier life
cannot recover to normal iron levels even with iron therapy. In contrast, iron deficiency during
later stages of development can be compensated with sufficient iron supplements. Iron-
deficiency anemia affects neurological development by decreasing learning ability, altering
motor functions, and permanently reducing the number of dopamine receptors and serotonin
levels. Iron deficiency during development can lead to reduced myelination of the spinal cord, as
well as a change in myelin composition. Additionally, iron-deficiency anemia has a negative
effect on physical growth. Growth hormone secretion is related to serum transferrin levels,
suggesting a positive correlation between iron-transferrin levels and an increase in height and
weight. This is also linked to pica, as it can be a cause.
Cause
3. A diagnosis of iron-deficiency anemia then requires further investigation as to its cause. It can be
caused by increased iron demand or decreased iron intake,[7]
and can occur in both children and
adults.
Blood loss.
Blood contains iron within red blood cells. So if a person loses blood, he or she will lose some
iron. Women with heavy periods are at risk of iron deficiency anemia because they lose blood
during menstruation. Slow, chronic blood loss within the body — such as from a peptic ulcer, a
hiatal hernia, a colon polyp or colorectal cancer — can cause iron-deficiency anemia.
Gastrointestinal bleeding can result from regular use of some over-the-counter pain relievers,
especially aspirin.[8]
A lack of iron in the diet.
The body regularly gets iron from the foods eaten. If a person consumes too little iron, over time
the body can become iron-deficient. Examples of iron-rich foods include meat, eggs, leafy green
vegetables and iron-fortified foods. For proper growth and development, infants and children
need iron from their diet, too.[8]
An inability to absorb iron.
Iron from food is absorbed into the bloodstream in the small intestine. An intestinal disorder,
such as celiac disease, which affects the intestine's ability to absorb nutrients from digested food,
can lead to iron-deficiency anemia. If part of the small intestine has been bypassed or removed
surgically, that may affect the ability to absorb iron and other nutrients.[8]
Pregnancy.
Without iron supplementation, iron deficiency anemia occurs in many pregnant women because
their iron stores need to serve their own increased blood volume as well as be a source of
hemoglobin for the growing fetus.[8]
The leading cause of iron deficiency worldwide is infestation with parasitic worms (hookworms,
whipworms, roundworms). Estimates of infection in the world population vary from a minimum
of a billion humans to as many as 5 or 6 billion.[1]
In addition to parasitosis, dietary insufficiency,
malabsorption, chronic blood loss, diversion of iron to fetal erythropoiesis during pregnancy,
intravascular hemolysis and hemoglobinuria or other forms of chronic blood loss should all be
considered, according to the patient's sex, age, and history. Other common causes include
gastrointestinal blood loss due to drug therapy (often in the case of NSAIDs or aspirin), and
hypochlorhydria/achlorhydria (often due to long-term proton pump inhibitor therapy). In babies
and adolescents, rapid growth may outpace dietary intake of iron, and result in deficiency
without disease or grossly abnormal diet.[7]
In women of childbearing age, heavy or long
menstrual periods can also cause mild iron-deficiency anemia.
4. Especially in adults over the age of 50, iron deficiency is often a sign of other disease in the
gastrointestinal tract, such as chronic bleeding from any cause (for example, a colon cancer) that
causes loss of blood in the stool. Such loss is often undetectable, except with special testing. In
adults, 60% of patients with iron-deficiency anemia have underlying gastrointestinal disorders
leading to chronic blood loss, and this percentage increases with patient age. Iron deficiency in
adult men from purely dietary causes is quite rare, and in such cases other causes of iron loss
must be vigorously sought until found.
Diagnosis
Anemia may be diagnosed from symptoms and signs, but when it is mild, it may not be
diagnosed from mild nonspecific symptoms. Pica, an abnormal craving for dirt, ice, or other
"odd" foods occurs variably in iron and zinc deficiency, but is neither sensitive or specific to the
problem, so is of little diagnostic help,
Anemia is often first shown by routine blood tests, which generally include a complete blood
count (CBC) which is performed by an instrument which gives an output as a series of index
numbers. A sufficiently low hemoglobin (Hb) by definition makes the diagnosis of anemia, and a
low hematocrit value is also characteristic of anemia. Further studies will be undertaken to
determine the anemia's cause. If the anemia is due to iron deficiency, one of the first abnormal
values to be noted on a CBC, as the body's iron stores begin to be depleted, will be a high red
blood cell distribution width, reflecting an increased variability in the size of red blood cells
(RBCs). In the course of slowly depleted iron status, an increasing RDW normally appears even
before anemia appears.
A low mean corpuscular volume (MCV) often appears next during the course of body iron
depletion. It corresponds to a high number of abnormally small red blood cells. A low MCV, a
low mean corpuscular hemoglobin and/or mean corpuscular hemoglobin concentration, and the
appearance of the RBCs on visual examination of a peripheral blood smear narrows the problem
to a microcytic anemia (literally, a "small red blood cell" anemia). The numerical values for
these measures are all calculated by modern laboratory equipment.
Blood smear of a patient with iron-deficiency anemia at 40X enhancement
The blood smear of a patient with iron deficiency shows many hypochromic (pale and relatively
colorless) and rather small RBCs, and may also show poikilocytosis (variation in shape) and
5. anisocytosis (variation in size). With more severe iron-deficiency anemia, the peripheral blood
smear may show target cells, hypochromic pencil-shaped cells, and occasionally small numbers
of nucleated red blood cells.[9]
Very commonly, the platelet count is slightly above the high limit
of normal in iron deficiency anemia (this is mild thrombocytosis). This effect was classically
postulated to be due to high erythropoietin levels in the body as a result of anemia, cross-reacting
to activate thrombopoietin receptors in the precursor cells that make platelets; however, this
process has not been corroborated. Such slightly increased platelet counts present no danger, but
remain valuable as an indicator even if their origin is not yet known.
The diagnosis of iron-deficiency anemia will be suggested by appropriate history (e.g., anemia in
a menstruating woman or an athlete engaged in long-distance running), the presence of occult
blood (i.e., hidden blood) in the stool, and often by other history.[10]
For example, known celiac
disease can cause malabsorption of iron. A travel history to areas in which hookworms and
whipworms are endemic may be helpful in guiding certain stool tests for parasites or their eggs.
Body-store iron deficiency is diagnosed by diagnostic tests, such as a low serum ferritin, a low
serum iron level, an elevated serum transferrin and a high total iron binding capacity. A low
serum ferritin is the most sensitive lab test for iron deficiency anemia. However, serum ferritin
can be elevated by any type of chronic inflammation and so is not always a reliable test of iron
status if it is within normal limits (i.e., this test is meaningful if abnormally low, but less
meaningful if normal).
Serum iron levels (i.e., iron not part of the hemoglobin in red cells) may be measured directly in
the blood, but these levels increase immediately with iron supplementation (the patient must stop
supplements for 24 hours), and pure blood-serum iron concentration in any case is not as
sensitive as a combination of total serum iron, along with a measure of the serum iron-binding
protein levels (TIBC). The ratio of serum iron to TIBC (called iron saturation or transferrin
saturation index or percent) is the most specific indicator of iron deficiency, when it is
sufficiently low. The iron saturation (or transferrin saturation) of < 5% almost always indicates
iron deficiency, while levels from 5% to 10% make the diagnosis of iron deficiency possible but
not definitive. Saturations over 12% (taken alone) make the diagnosis unlikely. Normal
saturations are usually slightly lower for women (>12%) than for men (>15%), but this may
indicate simply an overall slightly poorer iron status for women in the "normal" population.
Change in lab values in iron deficiency anemia
Change Parameter
Decrease ferritin, hemoglobin, MCV
Increase TIBC, transferrin, RDW
Iron-deficiency anemia and thalassemia minor present with many of the same lab results. It is
very important not to treat a patient with thalassemia with an iron supplement, as this can lead to
hemochromatosis (accumulation of iron in various organs, especially the liver). A hemoglobin
electrophoresis provides useful evidence for distinguishing these two conditions, along with iron
studies.
6. Gold standard
Conventionally, a definitive diagnosis requires a demonstration of depleted body iron stores
obtained by bone marrow aspiration, with the marrow stained for iron.[11][12]
Because this is
invasive and painful, while a clinical trial of iron supplementation is inexpensive and not
traumatic, patients are often treated based on clinical history and serum ferritin levels without a
bone marrow biopsy. Furthermore, a study published April 2009[13]
questions the value of
stainable bone marrow iron following parenteral iron therapy.
Treatment
Anemia is sometimes treatable, but certain types of anemia may be lifelong. If the cause is
dietary iron deficiency, eating more iron-rich foods, such as beans and lentils, or taking iron
supplements, usually with iron(II) sulfate, ferrous gluconate, or iron amino acid chelate ferrous
bisglycinate, or synthetic chelate NaFerredetate EDTA, will usually correct the anemia.
Alternatively, intravenous iron can be administered.
Recent research suggests the replacement dose of iron, at least in the elderly with iron
deficiency, may be as little as 15 mg per day of elemental iron. An experiment done in a group of
130 anemia patients showed a 98% increase in iron count when using an iron supplement with an
average of 100 mg of iron. Women who develop iron deficiency anemia in midpregnancy can be
effectively treated with low doses of iron (20–40 mg per day). The lower dose is effective and
produces fewer gastrointestinal complaints. The body apparently adapts to oral iron
supplementation, so iron is often effectively started at a comparatively low dose, then slowly
increased.
The difference between iron intake and iron absorption, also known as bioavailability, can be
great. Scientific studies indicate iron absorption problems are worsened when iron is taken in
conjunction with milk, tea, coffee and other substances. A number of methods that can help
mitigate this, including:
Fortification with ascorbic acid increases bioavailability in both presence and absence of
inhibiting substances, but is subject to deterioration from moisture or heat. Ascorbic acid
fortification is usually limited to sealed, dried foods, but individuals can easily take
ascorbic acid with a basic iron supplement for the same benefits.
Microencapsulation with lecithin binds and protects the iron particles from the action of
inhibiting substances. The primary benefit over ascorbic acid is durability and shelf life,
particularly for products like milk, which undergo heat treatment.
Using an iron amino acid chelate, such as NaFeEDTA, similarly binds and protects the
iron particles. A study by the hematology unit of the University of Chile indicated
chelated iron (ferrous bis-glycine chelate) can work with ascorbic acid to achieve even
higher absorption levels.
Separating intake of iron and inhibiting substances by a few hours
Using nondairy milk (such as soy, rice, or almond milk) or goats' milk instead of cows'
milk
7. Gluten-free diets can resolve some instances of iron-deficiency anemia, especially if it is
a result of celiac disease.
Heme iron, found only in animal foods, such as meat, fish and poultry, is more easily
absorbed than nonheme iron, found in plant foods and supplements.[14][15]
Iron bioavailability comparisons require stringent controls, because the largest factor affecting
bioavailability is the subject's existing iron level. Informal studies on bioavailability usually do
not take this factor into account, so exaggerated claims from health supplement companies based
on this sort of evidence should be ignored. Scientific studies are still in progress to determine
which approaches yield the best results and the lowest costs.
If anemia does not respond to oral treatments, it may be necessary to administer iron parenterally
using a drip or hemodialysis. Parenteral iron involves risks of fever, chills, backache, myalgia,
dizziness, syncope, rash, and with some preparations, anaphylactic shock. The total incidence of
adverse events is much lower than that with oral tablets.
A follow-up blood test is essential to demonstrate whether the treatment has been effective; it
can be undertaken after two to four weeks. With oral iron, this usually requires a delay of three
months for tablets to have a significant effect.
Iron supplementation and infection risk
Because one of the functions of elevated ferritin (an acute phase reaction protein) in acute
infections is thought to be to sequester iron from bacteria, it is generally thought that iron
supplementation (which circumvents this mechanism) should be avoided in patients who have
active bacterial infections. Replacement of iron stores is seldom such an emergency situation that
it cannot wait for such infections to be treated.
Some studies have found iron supplementation can lead to an increase in infectious disease
morbidity in areas where bacterial infections are common. For example, children receiving iron-
enriched foods have demonstrated an increased rate in diarrhea overall and enteropathogen
shedding. Iron deficiency protects against infection by creating an unfavorable environment for
bacterial growth. Nevertheless, while iron deficiency might lessen infections by certain
pathogenic diseases, it also leads to a reduction in resistance to other strains of viral or bacterial
infections, such as Salmonella typhimurium or Entamoeba histolytica. Overall, it is sometimes
difficult to decide whether iron supplementation will be beneficial or harmful to an individual in
an environment prone to many infectious diseases; however, this is a different question than the
question of supplementation in individuals who are already ill with a bacterial infection.