Supplements haemoglobin

Management has three important caveats. Firstly, it is mandatory that the causative lesion be reliably identified and, if possible, corrected. Here it should be remembered that a suboptimal intake of this vitamin is frequently seen in those who have diets deficient in vegetables and particularly fresh leafy products found in salads. Secondly, once treatment is initiated, there may be precipitous falls in serum potassium as ineffective haematopoiesis suddenly corrects and so removes the substantial delivery of the intracellular cation to the circulation renal compensation requires slightly longer to adapt and in that interval cardiac arrhythmia and death can occur. Eor this reason patients either need to have plasma electrolytes monitored initially or arbitrary oral potassium replacement supplied. Thirdly, there may be a transient increase in haemoglobin, which then reaches a plateau, and this is the consequence of exhausting available iron stores so that monitoring is necessary or supplementation with simple ferrous salts provided. 

Table 17.6 Haemoglobin levels (g/l) in a group of vegans before and after vitamin B12 supplementation...

As an example, we will consider (Table 17.6) some changes that occurred in haemoglobin levels in a group of vegans when given vitamin B12 supplementation. The study was paired, each individual providing a pre-treatment blood sample and then a further sample after 4 weeks of supplementation. 

Iron, zinc and copper are the most prevalent metals in the body, and perhaps not surprisingly are the most common supplementation treatments. Of these, iron dehciency is the most commonly observed and there are over 40 preparations of iron used therapeutically (including iron(II) sulfate iron(ll) fumarate iron(II) gluconate and iron(ll) succinate), compared with 3 for zinc (including zinc(II) sulfate). Notably, as folate plays a vital role as a cofactor in the biosynthesis of haeme (for haemoglobin), sometimes it is necessary to co-administer iron with folic acid in so-called compound oral iron preparations . 

Chuang CL, Liu RS, Wei YH, Huang TP, Tarng DC. Early prediction of response to intravenous iron supplementation by reticulocyte haemoglobin content and high-fluorescence reticulocyte count in haemodialysis patients. Nephrol Dial Transplant 2003 18 370-7. 

Different polypeptide chains may interact to form more complex multi-polypeptide proteins, wherein each individual polypeptide is known as a subunit. Subunit interactions and interrelationships are illustrated for the tetrameric protein haemoglobin (Figure 1.32). In the case of globular proteins, polypeptide chain association allows functions of individual polypeptide elements to be coordinated or indeed supplemented to give the whole molecule the opportunity to perform multiple biological functions. In the case of hbrous proteins, quaternary structure formation enhances overall molecular strength. 

A similar increase (2.4 g/L) in haemoglobin was also reported for intermittent MMN supplementation for 26 weeks in a study among Bangladeshi adoleseent girls with nutritional anaemia (Ahmed et al. 2010). However, a study among well-nourished Australian non-anaemic children found no effect of MMN fortification on haemoglobin status (Osendarp et al. 2007). 

Multiple micronutrient supplements can only marginally improve haemoglobin response in children and adolescent girls compared with iron and folic acid alone. 

In some species (human subjects and rodents) copper is an essential supplement of iron in haemoglobin manufacture (Hutchison, 1938). 

In a meantime, primiparous cows were fed the same basal diet than in the experiment described previously and supplemented daily with folic acid and rumen-protected methionine. The effects of weekly intramuscular injections of saline (0.95 NaCl) or 10 mg of vitamin Bj2 on milk production were monitored from 4 to 18 weeks of lactation. Supplementary vitamin Bj2 tended to increase milk yield from 28.5 to 31.1 kg/d and increased energy-corrected milk as well as milk yields of solids, fat and lactose but had no effect on dry matter intake or milk composition. Furthermore, packed cell volume and blood haemoglobin increased and serum methylmalonic acid decreased in cows that received vitamin Bj2 injections. The first observation suggests that low vitamin B 2 supply interfered with folate metabolism because folic acid deficiency, through its role in DNA synthesis, affects hematopoiesis (Bills et al., 1992). The second one indicates that low vitamin Bj2 supply interfered with the other vitamin B j 2-dependent enzyme, methylmalonyl-CoA mutase. These findings supported the hypothesis that vitamin Bj2 supply is suboptimal in early lactation (Girard and Matte, 2005) and may have limited the potential role of folic acid in these first studies. 

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