Iron Anemia

Most anemias are cansed by a nutritional imbalance (i.e., iron, vitamin B,2, and/or folic acid deficiencies). These deficiencies are widely distribnted in different areas of 

Heme-iron, only present in animal foods, is more bioavailable compared to other sources contained in grains and vegetables. The consumption of animal products enhances iron absorption associated with grains. Another important enhancer of iron absorption is vitamin C because it chelates nonheme-iron under stomach acidic conditions, and keeps it soluble under the relatively neutral pH conditions of the duodenum. Vitamin C reduces ferric iron (Fe+ ) into ferrous iron (Fe+ ) in the stomach. The ferrous form is more efficiently absorbed by the duodenum epithelial cells. Heme-iron enters the epithelial cells complexed to porphyrin myoglobin and hemoglobin. The absorbed iron is stored in ferritin molecules located inside the intestinal cells and transported bound to transferrin. There are known inhibitors of iron absorption, the most important being phytates and fiber. 

There are several ways to supplement iron. The most practical way is by the enrichment of selected foods. The most common vehicles are dry-milled products such as refined white rice, maize meals, and wheat flours. The most important sources are ferrous sulfate (32.1% Fe), ferrous (22.3% Fe) or ferric citrate (17% Fe), ferric chloride (34.4% Fe), and elemental iron (97% Fe). The last source is the least expensive but the one that has the lowest availability. There are new sources of highly bioavailable iron that include chelated and amino acid forms. 

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In most countries, cereals are the largest single source of dietary iron. The iron content of white flour is considerably lower than that of whole grain flour and flours of higher extraction rate. In Norway we have no fortification of the white flour, and the contribution of iron from cereals to the diet accounts for only 30%. Our neighbor country Sweden does enrich its white flour, with the result that over 60% of the iron in the diet comes from cereals. The frequency of iron anemia is, nevertheless, the same in the two countries. 

Just having anemia doesn t mean you are deficient in iron. Anemia can be caused by a deficiency of vitamin Bj2, folic acid, copper, manganese, or a substance called intrinsic factor, a specialized protein that transports vitamin Bjo from the stomach to the bloodstream. If you believe you are anemic, go to your doctor and find out what is causing it. On the other hand, if you know you are not getting enough iron, then you are a good candidate for iron supplements. 

Transferrin is essential for movement of iron and without it, as in genetic absence of transferrin, iron overload occurs in tissues. This hereditary atransferrinemia is coupled with iron-deficiency anemia. The iron overload in hereditary or acquired hemochromatosis results in fully saturated transferrin and is treated by phlebotomy (10). 

In the treatment of poisoning by lead or other metal ions, higher concentrations of chelant can be safely obtained in humans by administering Na2CaEDTA rather than Na EDTA. The metal ion is bound by displacing small amounts of Ca " that the body can tolerate. Use of Na EDTA would result in calcium chelation and thus serious depletion of calcium in the body fluids (44). Removal of iron in Cooley s anemia is accompHshed by using chelants that are relatively specific for iron (45). 

In addition to its role in preventing scurvy (see Human Biochemistry box Ascorbic Acid and Scurvy and also Chapter 6), ascorbic acid also plays important roles in the brain and nervous system. It also mobilizes iron in the body, prevents anemia, ameliorates allergic responses, and stimulates the immune system. 

Thus, our attention should shift from the concern of potential adverse effects to the health benefits imparted by hormonal contraceptives. The use of oral contraceptives for at least 12 months reduces the risk of developing endometrial cancer by 50%. Furthermore, the risk of epithelial ovarian cancer in users of oral contraceptives is reduced by 40% compared with that on nonusers. This kind of protection is already seen after as little as 3-6 months of use. Oral contraceptives also decrease the incidence of ovarian cysts and fibrocystic breast disease. They reduce menstrual blood loss and thus the incidence of iron-deficiency anemia. A decreased incidence of pelvic inflammatory disease and ectopic pregnancies has been reported as well as an ameliorating effect on the clinical course of endometriosis. 

Anemia is a decrease in the number of red blood cells (RBCs), a decrease in die amount of hemoglobin in RBCs, or bodi a decrease in die number of RBCs and hemoglobin. When diere is an insufficient amount of hemoglobin to deliver oxygen to die tissues, anemia exists. There are various types and causes of anemia For example, anemia can be die result of blood loss, excessive destruction of RBCs, inadequate production of RBCs, and deficits in various nutrients, such as in iron deficiency anemia Once the type and cause have been identified, die primary health care provider selects a method of treatment. 

The anemias discussed in this chapter include iron deficiency anemia, anemia in patients witii chronic renal disease pernicious anemia, and anemia resulting from a folic acid deficiency. Table 45-1 defines these anemias. Drugp used in treatment of anemia are summarized in die Summary Drug Table Drugp Used in die Treatment of Anemia. 

Iron deficiency anemia is by far die most common type of anemia Iron is a component of hemoglobin, which is in RBCs. It is the iron in the hemoglobin of RBCs diat... 

Iron salts, such as ferrous sulfate or ferrous gluconate, are used in the treatment of iron deficiency anemia, which occurs when there is a loss of iron that is greater than the available iron stored in the body. Iron preparations act by elevating the serum iron concentration, which replenishes hemoglobin and depleted iron stores. 

Iron dextran is a parenteral iron that is also used for die treatment of iron deficiency anemia It is primarily used when the patient cannot take oral drugs or when the patient experiences gastrointestinal intolerance to oral iron administration. Other iron preparations, both oral and parenteral, used in the treatment of iron deficiency anemia can be found in the Summary Drug Table Dragp Used in the Treatment of Anemia... 

Iron deficiency Anemia characterized by an inadequate amount of iron in the body to produce hemoglobin... 

This drug is not used for treatment of severe anemia or as a substitute for emergency transfusion. However, supplemental iron maybe ordered during therapy with epoetin. 

Taking the contraceptive hormones provides health benefits not related to contraception, such as regulating the menstrual cycle and decreased blood loss, and incidence of iron deficiency anemia, and dysmenorrhea Health benefits related to the inhibition of ovulation include a decrease in ovarian cysts and ectopic pregnancies. hi addition, there is a decrease in fibrocyctic breast disease, acute pelvic inflammatory disease endometrial cancer, ovarian cancer, maintenance of bone density, and symptoms related to endometriosis in women taking contraceptive hormones. Newer combination contraceptives such as norgestimate and ethinyl estradiol... 

Ferrous gluconate is the black dye used to color ripe olives. It is also used as an iron supplement to treat iron-deficiency anemia. 

A healthy adult human body contains about 3 g of iron, mostly as hemoglobin. Because about 1 mg is lost daily (in sweat, feces, and hair), and women lose about 20 mg in each menstrual cycle, iron must be ingested daily to maintain the balance. Iron deficiency, or anemia, results in reduced transport of oxygen to the brain and muscles, and an early symptom is chronic tiredness. 

Anemias, reductions in the number of red blood cells or of hemoglobin in the blood, can reflect impaired synthesis of hemoglobin (eg, in iron deficiency Chapter 51) or impaired production of erythrocytes (eg, in folic acid or vitamin Bjj deficiency Chapter 45). Diagnosis of anemias begins with spectroscopic measurement of blood hemoglobin levels. 

Inorganic iron is absorbed only in the (reduced) state, and for that reason the presence of reducing agents will enhance absorption. The most effective compound is vitamin C, and while intakes of 40-60 mg of vitamin C per day are more than adequate to meet requirements, an intake of 25-50 mg per meal will enhance iron absorption, especially when iron salts are used to treat iron deficiency anemia. Ethanol and fructose also enhance iron absorption. Heme iron from meat is absorbed separately and is considerably more available than inorganic iron. However, the absorption of both inorganic and heme iron is impaired by calcium—a glass of milk with a meal significantly reduces availabiUty. 

Attention to iron metabolism is particularly important in women for the reason mentioned above. Additionally, in pregnancy, allowances must be made for the growing fetus. Older people with poor dietary habits ( tea and toasters ) may develop iron deficiency. Iron deficiency anemia due to inadequate intake, inadequate utilization, or excessive loss of iron is one of the most prevalent conditions seen in medical practice. 

Secondary kemochromatosis can occur after repeated transfusions (eg, for treatment of sickle cell anemia), excessive oral intake of iron (eg, by African Banm peoples who consume alcoholic beverages fermented in containers made of iron), or a number of other condi-... 

Transferrin binds iron, transporting it to sites where it is required. Ferritin provides an intracellular store of iron. Iron deficiency anemia is a very prevalent disorder. Hereditary hemochromatosis has been shown to be due to mutations in HFE, a gene encoding the protein HFE, which appeats to play an important role in absorption of iron. 

Iron deficiency anemia Inadequate intake or excessive loss of iron... 

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