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tumor\ton\tthe\tadrenal\tor\tpituitary\tgland.\tWeight\tgain,\tinsulin\tresistance,\thigh\tblood\tsugar,\texcessive\nthirst,\teasy\tbruising,\tdepression,\tmuscle\tloss,\n\tand\tweakness\tare\tcommon\tsymptoms.\tBecause\tcortisol
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causes\tbone\tloss\tover\ttime,\ta\tdiet\trich\tin\tcalcium\tand\tvitamin\tD\tmay\thelp\tprevent\tosteoporosis.\nReducing\tsodium,\toptimal\thydration,\tand\tcaloric\tawareness\tcan\talso\tassist\twith\tweight\tmanagement\nand\tthe\tprevention\tof\tfluid\tretention.\nAddison’s\tdisease\nPrimary\tadrenal\tinsufficiency,\talso\tknown\tas\t\nAddison’s\tdisease\n,\tis\trare.\tIn\tthis\tcondition,
|
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Addison’s\tdisease\n,\tis\trare.\tIn\tthis\tcondition,\ninsufficient\tsteroid\thormones\tare\tproduced\tin\tspite\tof\tadequate\tlevels\tof\tthe\thormone\nadrenocorticotropic\thormone\t(ACTH).\tPeople\twith\tAddison’s\tdisease\tlose\tthe\tability\tto\tappropriately\nregulate\tblood\tsugar\tand\twill\thave\tlow\tlevels\tof\tcortisol,\taldosterone,\tepinephrine,\tand
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] |
norepinephrine.\tThis\tleads\tto\tloss\tof\tappetite,\tfatigue,\tlow\tblood\tpressure,\tnausea\tand\tvomiting,\tand,\nfor\tsome,\tdarkening\tof\n\tskin\ton\tthe\tface\tand\tneck.\tPatients\twith\tAddison’s\tdisease\thave\tan\tincreased\nneed\tfor\tsalt\tand\twater\tand\talso\tneed\tto\teat\tregular\tbalanced\tmeals\t(with\tlow-glycemic\ncarbohydrate\tand\tprotein)\tto\tregulate\tblood\tsugar.
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carbohydrate\tand\tprotein)\tto\tregulate\tblood\tsugar.\nAdrenal\tinsufficiency/adrenal\tfatigue\nAdrenal\tfatigue\n\thas\tbeen\tidentified\tas\ta\tcollection\tof\tsigns\tand\tsymptoms\tcaused\tby\tthe\tdecreased\nability\tof\tthe\tadrenal\tglands\tto\trespond\n\tadequately\tto\tstress.\tA\tvariety\tof\tterms\tare\tfound\tin\tthe
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adequately\tto\tstress.\tA\tvariety\tof\tterms\tare\tfound\tin\tthe\nscientific\tliterature\tthat\taddress\tadrenal\tfatigue,\tincluding\tsubclinical\tadrenal\tinsufficiency,\tadrenal\nstress,\tadrenal\texhaustion,\tadrenal\tburnout,\tand\tadrenal\timbalance\t(\nAllen\tJr,\t2013\n).\tThe\tadrenals
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Allen\tJr,\t2013\n).\tThe\tadrenals\nare\tthe\ttwo\ttriangular-shaped\tglands\tlocated\tat\tthe\ttop\tof\teach\tkidney\tand\tare\tresponsible\tprimarily\nfor\tgoverning\tthe\tbody’s\tadaptations\n\tto\tstress\tof\tany\tkind.\tUnder\tthe\tinfluence\tof\tstress,\tthe\nadrenals\twill\trespond\twith\tincreased\thormone\tproduction,\twhich\tcan\tcause\televated\tblood\tsugar\tand
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blood\tpressure.\tOver\ttime,\tthe\tadrenal\tcan\tbecome\tdecompensated,\twhere\tthe\thormone\toutput\tmay\nbe\tdiminished.\tThis\tis\toften\treferred\tto\tas\tadrenal\tfatigue.\tThis\tcan\toccur\twhether\tthe\tsource\tof\nstress—physical,\temotional,\tor\tpsychological—is\tchronic\n\tand\tcontinues\tto\tpersist\tcausing\ta
|
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and\tcontinues\tto\tpersist\tcausing\ta\ncumulative\teffect,\tor\tis\ta\tvery\tintense\tsingle\tevent\tstressor.\tIn\tother\twords,\tthe\tadrenal\tglands\tare\nunable\tto\tkeep\tpace\twith\tthe\tdemands\tof\tperpetual\tfight-or-flight\tarousal,\tresulting\tin\tsubclinical\nadrenal\tdysfunction.\tThe\tmost\tcommon\tsymptoms\tof\tadrenal\tfatigue\tinclude,\tbut\tare\tnot\tlimited\tto,
|
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] |
excessive\tfatigue\tand\texhaustion,\thair\tloss,\thypoglycemia,\n\thormone\timbalance,\tpoor\tdigestion,\tlow\nimmune\tfunction,\tslow\trecovery\tfrom\tillness,\tinability\tto\tconcentrate,\tand\tinability\tto\tcope\twith\nstressors.\nChronic\tadrenal\tstress\tcauses\tthe\tfollowing\t(\nSun\tet\tal,\t2016\n;\t\nTsigos\tand\tChrousos,\t2002\n):\n•
|
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] |
Sun\tet\tal,\t2016\n;\t\nTsigos\tand\tChrousos,\t2002\n):\n•\t\nAffects\tcommunication\tbetween\tthe\tbrain\tand\thormone-secreting\tglands.\tThe\thypothalamus\nand\tpituitary\tgland\tdirect\thormone\tproduction,\tincluding\tthat\tof\n\tthe\tthyroid.\tWhen\tthe\nhypothalamus\tand\tpituitary\tweaken\tbecause\tof\tchronic\tadrenal\tstress,\tthey\tare\tnot\table\tto
|
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] |
communicate\twell\twith\tthe\tthyroid\tgland.\n•\t\nIncreases\tthyroid-binding\tprotein\tactivity,\tso\tthat\tthyroid\thormones\tcannot\tget\tinto\tcells\tto\ndo\ttheir\tjob.\n•\t\nHampers\tthe\tconversion\tof\tT\n4\n\tto\tactive\tforms\tof\tT\n3\n,\twhich\tcan\tlead\tto\tfatigue.\n•\t\nInterferes\twith\tthe\tbiotransformation\t(detoxification)\n\tpathways\tthrough\twhich\tthyroid
|
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pathways\tthrough\twhich\tthyroid\nhormones\texit\tthe\tbody,\tleading\tto\tthyroid\thormone\timbalance.\n•\t\nCauses\tcells\tto\tlose\tsensitivity\tto\tthyroid\thormones.\n•\t\nWeakens\tthe\timmune\tbarriers\tof\tthe\tdigestive\ttract,\tlungs,\tand\tbrain;\tpromotes\tpoor\nimmune\tregulation.\nThe\timpact\tof\thigh\tstress\ton\tintestinal\tmicroflora\thas\tbeen\texamined\tas\twell.\tA\tsignificant
|
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] |
decrease\tin\tthe\tnumber\tof\t\nBifidobacteria\n\tand\t\nLactobacilli\n\twas\treported.\tConversely,\tan\tincrease\tin\nthe\tnumber\tof\t\nEscherichia\tcoli\n\tand\tenterobacteria\twere\talso\treported,\tsuggesting\tthat\tthe\tincreased\nchronic\tstress\tdisrupts\tintestinal\tmicroflora\tecology.\tThe\tauthors\tpropose\tis\tthat\tstress\tinduces
|
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] |
increased\tpermeability\tof\tthe\tgut,\tallowing\tbacteria\tand\tbacterial\tantigens\tto\tcross\tthe\tepithelial\nbarrier\tand\tactivate\ta\tmucosal\timmune\tresponse,\n\twhich\tin\tturn\talters\tthe\tcomposition\tof\tthe\nmicrobiome\tand\tleads\tto\tenhanced\thypothalamic-pituitary-adrenal\t(HPA)\tactivation\t(\nDinan\tand\nCryan,\t2012\n).
|
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Dinan\tand\nCryan,\t2012\n).\nThese\tare\tsome\tof\tthe\tways\tadrenal\tstress\tdirectly\taffect\tthyroid\tfunction\t(\nHerman\tet\tal,\t2016\n).\nChronic\tadrenal\tstress\taffects\tother\tsystems\tof\tthe\tbody,\twhich\tin\tturn\tdecreases\tthyroid\tfunction.\nFor\texample,\tthe\tadrenal\thormone\t\ncortisol\n\tplays\n\ta\tlarge\trole\tin\tthyroid\thealth.\tCortisol\tis\ta\tlife-
|
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] |
cortisol\n\tplays\n\ta\tlarge\trole\tin\tthyroid\thealth.\tCortisol\tis\ta\tlife-\nsustaining\thormone\tessential\tto\tthe\tmaintenance\tof\thomeostasis.\tIt\toften\tis\tcalled\tthe\t“stress\nhormone”\tbecause\tit\tinfluences,\tregulates,\tor\tmodulates\tmany\tof\tthe\tchanges\tthat\toccur\tin\tthe\tbody\nin\tresponse\tto\tstress,\tincluding,\tbut\tnot\tlimited,\tto\tthe\tfollowing:\n•
|
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] |
•\t\nAntiinflammatory\tactions\n•\t\nBlood\tglucose\tlevels\n•\t\nBlood\tpressure\n•\t\nCentral\n\tnervous\tsystem\tactivation\n•\t\nFat,\tprotein,\tand\tcarbohydrate\tmetabolism\tto\tmaintain\tblood\tglucose\n•\t\nHeart\tand\tblood\tvessel\ttone\tand\tcontraction\n•\t\nImmune\tresponses\nCortisol\tlevels\tfollow\ta\tcircadian\trhythm\tand\tnormally\tfluctuate\tthroughout\tthe\tday\tand\tnight,
|
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peaking\tat\tabout\t8\ta.m\tand\treaching\ta\tlow\tat\tabout\t4\tp.m\t(\nAllen\tJr,\t2013\n).\tIt\tis\tvery\timportant\tthat\nbodily\tfunctions\tand\tcortisol\tlevels\n\treturn\tto\tnormal\tafter\ta\tstressful\tevent.\tAdrenal\tfatigue\tappears\nto\toccur\twhen\tthe\tamount\tof\tstress\tor\tcombined\tstresses\toverextends\tthe\tcapacity\tof\tthe\tbody\tto
|
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compensate\tfor\tand\trecover\tfrom\tthat\tstress.\tWhen\tthis\thappens\trepeatedly,\tit\texhausts\tthe\tadrenal
|
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and\tthyroid\tglands,\tas\twell\tas\tthe\thypothalamus\tand\tthe\tpituitary\tgland.\tOver\ttime\tthis\texhaustion\nleads\tto\tfunctional\thypothyroidism.\n\tIn\taddition,\tconstant\tcortisol\tproduction\tincreases\trisk\tfor\nobesity\tand\tweakens\tthe\tgastrointestinal\t(GI)\ttract,\tmaking\tone\tmore\tsusceptible\tto\tinflammation,\ndysbiosis\t(poor\tgut\thealth),\tand\tinfection\t(
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] |
dysbiosis\t(poor\tgut\thealth),\tand\tinfection\t(\nFoster,\t2017\n;\t\nvan\tder\tValk\tet\tal,\t2018\n).\nThe\tfollowing\tinclude\tcommon\tintegrative\tinterventions\tin\tthe\ttreatment\tof\tadrenal\tfatigue\t(\nAllolio\net\tal,\t2007\n;\t\nCharmandari,\t2014\n):\n•\t\nB-complex\tvitamins\n\tto\tprovide\tcofactors\tfor\tadrenal\thormone\tproduction\n•\t\nExercise\tin\tmoderation\n•
|
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] |
•\t\nExercise\tin\tmoderation\n•\t\nLow-glycemic\tload,\tnutrient-dense\tdiet\n•\t\nAntianxiolytic/sedative\tbotanicals\t(i.e.\tchamomile\tand\tlavender)\t(\nHead\tand\tKelly,\t2009\n).\n•\t\nProbiotics\n•\t\nOptimizing\tsleep\thabits\n•\t\nRelaxation\tand\tstress\tmanagement\nOvert\tstressors\tsuch\tas\tchildhood\temotional\tabuse\tand\tposttraumatic\tstress\tdisorder\t(PTSD)\tmay\nresult\tin
|
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] |
result\tin\n\tcortisol\thyperactivity,\tthus\tleading\tto\tpituitary\tand\tadrenal\thyperreactivity\tand\tadrenal\nfatigue\tand\tdecompensation\t(\nRasmusson\tet\tal,\t2001\n).\tIncreased\tcortisol\tsignaling,\thowever,\thas\nbeen\tshown\tto\tbe\tneurocognitively\tbeneficial\tin\tdepressed\twomen\twith\ta\thistory\tof\tmaltreatment\n(\nAbercrombie\tet\tal,\t2018\n).\nCLINICAL\tCASE\tSTUDY
|
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0.08916158974170685,
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] |
(\nAbercrombie\tet\tal,\t2018\n).\nCLINICAL\tCASE\tSTUDY\nFrank\tis\ta\t72-year-old\tblack\tman\tfrom\tJamaica\twho\tmoved\tto\tthe\n\tUnited\tStates\t2\tyears\tago.\tHe\nhas\tbeen\tdiagnosed\twith\thypothyroidism\tthis\tpast\tyear.\tHe\tcomes\tto\tyour\tclinic\ttaking\tSynthroid,\ngarlic,\tand\tchamomile.\tHis\tdiet\thistory\tindicates\tdaily\tintake\tof\tchicken,\trice,\tcelery,\tgreen
|
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] |
pepper,\tmango,\tand\tpapaya.\tHe\tstates\tthat\the\thas\tbeen\tvery\ttired\tlately,\thas\tlittle\tenergy,\tand\thas\nconstipation.\tHis\thormone\tlevels\ton\this\tlast\tmedical\treport\twere\tthyroxine\t(T\n4\n):\t1.7\tng/dL,\ntriiodothyronine\t(T\n3\n):\t75\tng/dL,\tand\tthyroid-stimulating\thormone\t(TSH):\t6\tU/mL,\tindicative\tthat\nhis\thypothyroidism\tis\tstill\tnot\twell\tcontrolled.
|
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his\thypothyroidism\tis\tstill\tnot\twell\tcontrolled.\nNutrition\tdiagnostic\tstatement\n•\t\nFood-medication\tinteraction\trelated\tto\tmixing\tSynthroid\twith\tfoods\tand\therbs\tthat\taggravate\nthyroid\tdysfunction\tas\tevidenced\tby\tfatigue,\tconstipation,\thigh\tTSH,\tand\tlow\tserum\tT\n3\n\tand\nT\n4\n.\nNutrition\n\tcare\tquestions\n1.
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3\n\tand\nT\n4\n.\nNutrition\n\tcare\tquestions\n1.\t\nWhat\tother\tinformation\tdo\tyou\tneed\tfor\ta\tmore\tthorough\tassessment?\n2.\t\nTaking\tinto\tconsideration\this\tJamaican\theritage,\tadvice\twould\tyou\toffer\tFrank\tabout\this\ndiet?\n3.\t\nWhat\tfoods\tand\tsupplements\tconflict\twith\tSynthroid?\n4.
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] |
diet?\n3.\t\nWhat\tfoods\tand\tsupplements\tconflict\twith\tSynthroid?\n4.\t\nBecause\the\tis\ta\trecent\timmigrant,\twhat\tpotential\tstressors\tmay\the\tbe\texperiencing?\nUseful\twebsites\nAmerican\tAssociation\tof\tClinical\n\tEndocrinologists\nAmerican\tThyroid\tAssociation\nEndocrine\tWeb\nThyroid\tDisease\tInformation\nReferences\nAbercrombie\tHC,\tFrost\tCP,\tWalsh\tEC.\tet\tal.
|
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] |
References\nAbercrombie\tHC,\tFrost\tCP,\tWalsh\tEC.\tet\tal.\t\nNeural\tsignaling\tof\tcortisol,\tchildhood\temotional\nabuse\tand\tdepression-related\tmemory\tbias\n\tBiol\tPsychiatry\tCogn\tNeurosci\tNeuroimaging\n2018;3:\t274-284.\nAllen\tLV\tJr.\t\nAdrenal\tfatigue\n\tInt\tJ\tPharm\tCompd\t2013;17:\t39-44.\nAllolio\tB,\tArlt\tW,\tHahner\tS.
|
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] |
Int\tJ\tPharm\tCompd\t2013;17:\t39-44.\nAllolio\tB,\tArlt\tW,\tHahner\tS.\t\nDHEA:\twhy,\twhen,\tand\thow\tmuch-DHEA\treplacement\tin\tadrenal\ninsufficiency\n\tAnn\tEndocrinol\t(Paris)\t2007;68:\t268-273.\nAmbali\tSF,\tOrieji\tC,\tAbubakar\tWO.\tet\tal.\t\nAmeliorative\teffect\tof\tVitamin\tC\ton\talterations\tin
|
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] |
Ameliorative\teffect\tof\tVitamin\tC\ton\talterations\tin\nthyroid\thormone\tconcentrations\tinduced\tby\tsub-chronic\tCo-administration\tof\tChloropyrifos\nand\tLead\tin\twistar\trats\n\tJ\tThyroid\tRes\t2011;\t214924.\nAmerican\tThyroid\tAssociation:\t\nThyroid\tdisease\tand\n\tpregnancy\n\t(website).\nhttp://www.thyroid.org/thyroid-disease-and-pregnancy/\n.
|
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(website).\nhttp://www.thyroid.org/thyroid-disease-and-pregnancy/\n.\nAmin\tAl,\tHegazy\tNM,\tIbrahim\tKS.\tet\tal.\t\nThyroid\thormone\tindices\tin\tcomputer\tworkers\twith\nemphasis\ton\tthe\trole\tof\tZinc\tsupplementation\n\tOpen\tAccess\tMaced\tJ\tMed\tSci\t2016;4:\t296-301.\nBaeke\tF,\tTakiishi\tT,\tKorf\tH.\tet\tal.\t\nVitamin\tD:\tmodulator\tof\tthe\timmune\tsystem\n\tCurr\tOpin
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Vitamin\tD:\tmodulator\tof\tthe\timmune\tsystem\n\tCurr\tOpin\nPharmacol\t2010;10:\t482-496.\nBajaj\tJK,\tSalwan\tP,\n\tSalwan\tS.\t\nVarious\tpossible\ttoxicants\tinvolved\tin\tthyroid\tdysfunction:\ta\nreview\n\tJ\tClin\tDiagn\tRes\t2016;10:\tFE01-\tFE03.\nBarker\tJM,\tLiu\tE.\t\nCeliac\tdisease:\tpathophysiology,\tclinical\tmanifestations,\tand\tassociated\nautoimmune\tconditions
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] |
autoimmune\tconditions\n\tAdv\tPediatr\t2008;55:\t349-365.
|
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] |
31\nMedical\tnutrition\ttherapy\tfor\nanemia\nMichelle\tLoy,\tMPH,\tMS,\tRDN\nKEY\tTERMS\nanemia\naplastic\tanemia\nceruloplasmin\nferritin\nferroprotein\nglossitis\nhematocrit\nheme\tiron\nhemoglobin\nhemolytic\tanemia\nhepcidin\nhereditary\themochromatosis\nolotranscobalamin\tII\t(holo\tTCII)\nhypochromic\nintrinsic\tfactor\t(IF)\niron\tdeficiency\tanemia\nkoilonychia\nmacrocytic\tanemia
|
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] |
iron\tdeficiency\tanemia\nkoilonychia\nmacrocytic\tanemia\nmeat-fish-poultry\n\t(MFP)\tfactor\nmegaloblastic\tanemia\nmicrocytic\tanemia\nnonheme\tiron\nnormochromic\nnutritional\tanemias\npagophagia\npernicious\tanemia\npica\nplasma\npolycythemia\nprotoporphyrin\nreticulocytosis\nrestless\tlegs\tsyndrome\t(RLS)\nserum\nsickle\tcell\tdisease\t(SCD)
|
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] |
restless\tlegs\tsyndrome\t(RLS)\nserum\nsickle\tcell\tdisease\t(SCD)\nsideroblastic\t(pyridoxine-responsive)\tanemia\nsoluble\tserum\ttransferrin\treceptors\t(STFRs)\nsports\tanemia\nthalassemia\ntotal\tiron-binding\n\tcapacity\t(TIBC)
|
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] |
transferrin\ntransferrin\treceptor\ntransferrin\tsaturation\nAnemia\n\tis\tthe\tpredominant\thematologic\tdisorder\tin\tthe\tUnited\tStates\tand\tis\tassociated\twith\tmedical\nconsequences\tthat\tinfluence\tmorbidity\tand\tmortality.\tAnemia\taffects\t5.6%\tof\tthe\tnation’s\tpopulation\nwith\tthe\tprevalence\tbeing\thighest\tamong\twomen\tof\treproductive\tage,\tadults\t60\tyears\tor\tolder,
|
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blacks,\tand\tHispanics\t(\nLe,\t2016\n).\tAnemia\tis\talso\ta\tserious\tglobal\thealth\tburden\taffecting\t2\tbillion\npeople\tworldwide\twith\tthe\thighest\trates\toccurring\tin\tSouth\tAsia\tand\tcentral\tand\twest\tsub-Saharan\nAfrica\t(\nKassebaum,\t2016\n).\tGlobally,\tyoung\tchildren,\twomen,\tand\tolder\tadults\tare\tat\thighest\trisk\tof
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] |
developing\tanemia.\tTo\tbest\taddress\tthis\tserious\thealth\tproblem,\tnutrition\tprofessionals\tneed\ta\tsolid\nunderstanding\tof\tthe\trelevant\tterminology\n\talong\twith\tthe\tetiology,\tpathophysiology,\tand\tmedical\tand\nnutritional\tmanagement\tof\tthe\tmost\tcommon\ttypes\tof\tanemia.\nHemoglobin
|
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] |
nutritional\tmanagement\tof\tthe\tmost\tcommon\ttypes\tof\tanemia.\nHemoglobin\n\tis\ta\tconjugated\tprotein\tcontaining\tfour\theme\tgroups\tand\tglobin;\tit\tis\tthe\toxygen-\ncarrying\tpigment\tof\tthe\terythrocytes.\tThe\t\nhematocrit\n\tis\tthe\tvolume\tpercentage\tof\terythrocytes\tin\nthe\tblood.\t\nPlasma\n\tis\tthe\tliquid\tportion\tof\twhole\tblood\tcontaining\tcoagulation\tfactors;\t\nserum
|
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0.0774294063448906,
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0.10770367830991745,
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0.051743458956480026,
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0.03258562833070755,
0.0931025967001915,
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0.06818906962871552,
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0.019405491650104523,
0.13669757544994354,
0.03920798748731613,
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] |
serum\n\tis\tthe\nliquid\tportion\tof\twhole\tblood\twithout\tcoagulation\tfactors.\nAnemia\tis\ta\tdeficiency\tin\tthe\tsize\tor\tnumber\tof\tred\tblood\tcells\t(RBCs)\tor\tthe\tamount\tof\themoglobin\nthey\tcontain.\tThis\tdeficiency\tlimits\tthe\texchange\tof\toxygen\tand\tcarbon\tdioxide\tbetween\tthe\tblood
|
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0.0419715940952301,
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0.009260150603950024,
0.02742178738117218,
0.04932788759469986,
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0.028908120468258858,
0.09114672988653183,
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0.12739145755767822,
0.013949934393167496,
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0.04078671336174011,
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0.049592651426792145,
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0.08581289649009705,
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0.03248194232583046,
0.08215978741645813,
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0.0801442489027977,
0.016319574788212776,
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0.043260928243398666,
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0.02148413471877575,
0.06801680475473404,
0.01605853997170925,
0.043043725192546844,
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0.052651334553956985,
0.11490640044212341,
0.06989312171936035,
-0.04149718955159187
] |
and\tthe\ttissue\tcells.\tAnemia\tclassification\tis\tbased\ton\tcell\tsize—macrocytic\t(large),\tnormocytic\n(normal),\tand\tmicrocytic\t(small)—and\n\ton\themoglobin\tcontent:\t\nhypochromic\n\t(pale\tcolor\tfrom\ndeficiency\tof\themoglobin)\tand\t\nnormochromic\n\t(normal\tcolor)\t(\nTable\t31.1\n).
|
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] |
TABLE\t31.1\nMorphologic\tClassification\tof\tAnemia\nMorphologic\nType\tof\nAnemia\nUnderlying\nAbnormality\nClinical\tSyndromes\nTreatment\nMacrocytic\t(MCV\t>\t94;\tMCHC\t>\t31)\nMegaloblastic\nVitamin\tB\n12\ndeficiency\nPernicious\tanemia\nVitamin\tB\n12\nFolate\tdeficiency\nNutritional\tmegaloblastic\nanemias,\tmalabsorption\nsyndromes\nFolic\tacid\nInherited\ndisorders\tof
|
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] |
anemias,\tmalabsorption\nsyndromes\nFolic\tacid\nInherited\ndisorders\tof\nDNA\tsynthesis\nOrotic\taciduria\nSickle\tcell\tdisease\nTreatment\tbased\ton\tthe\tnature\tof\nthe\tdisorder\nDrug-induced\ndisorders\tof\nDNA\tsynthesis\nSide\teffects\tof\nchemotherapeutic\tagents,\nanticonvulsants,\toral\ncontraceptives\nDiscontinue\toffending\tdrug\tand\nadminister\tfolic\tacid
|
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] |
contraceptives\nDiscontinue\toffending\tdrug\tand\nadminister\tfolic\tacid\nNonmegaloblastic\nAccelerated\nerythropoiesis\nHemolytic\tanemia\nTreatment\tof\tunderlying\tdisease\nHypochromic\tMicrocytic\t(MCV\t<\t80;\tMCHC\t<\t31)\nIron\tdeficiency\nChronic\tloss\tof\n\tblood,\ninadequate\tdiet,\timpaired\nabsorption,\tincreased\ndemands\nFerrous\tsulfate\tor\tferrous\tbis
|
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absorption,\tincreased\ndemands\nFerrous\tsulfate\tor\tferrous\tbis\nglycinate\tand\tcorrection\tof\nunderlying\tcause\nDisorders\tof\nglobin\nsynthesis\nThalassemia\nHemoglobin\tE\nHemoglobin\tC\nNonspecific\nMild\t–\tdoes\tnot\trequire\ntreatment;\nSevere\t–\tfrequent\tblood\ntransfusions\tto\tprovide\nhealthy\tRBCs\twith\tnormal\nHgb\nDisorders\tof\nporphyrin\tand\nheme\nsynthesis
|
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-0.06471128016710281,
-0.013044839724898338,
-0.05997136980295181,
-0.015316253527998924,
-0.0311767365783453,
0.062394771724939346,
-0.008747192099690437,
-0.07764896750450134,
-0.040868062525987625,
0.10376733541488647,
0.05180823430418968,
-0.02538263611495495,
-0.009166323579847813,
0.10057803243398666,
0.011221209540963173,
-0.051851607859134674,
-0.03810897096991539,
0.07170096039772034,
-0.013565943576395512,
-0.07979365438222885,
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0.03783256188035011,
0.051626697182655334,
-0.031559694558382034,
0.019174939021468163,
0.007577213924378157,
0.06680483371019363,
0.09262517839670181,
0.04272433742880821,
-0.034487441182136536
] |
Hgb\nDisorders\tof\nporphyrin\tand\nheme\nsynthesis\nPyridoxine-responsive\n\tanemia\nPyridoxine\nOther\tdisorders\nof\tiron\nmetabolism\nCopper\tdeficiency\nCopper\nNormochromic\tNormocytic\t(MCV\t82-92;\tMCHC\t>\t30)\nRecent\tblood\tloss\nVarious\nTransfusion,\tiron,\tcorrection\tof\nunderlying\tcondition\nOverexpansion\tof\nplasma\tvolume\nEdema\tof\tpregnancy\nRestore\thomeostasis
|
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0.06298688054084778,
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0.012727076187729836,
0.12944439053535461,
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0.025231419131159782,
0.01474071852862835,
0.03762413561344147,
0.11498836427927017,
0.01889798231422901,
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0.037202853709459305,
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0.024242587387561798,
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0.051159534603357315,
0.0551399290561676,
0.0926903486251831,
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] |
Overexpansion\tof\nplasma\tvolume\nEdema\tof\tpregnancy\nRestore\thomeostasis\nHemolytic\ndiseases\nOverhydration\nTreatment\tbased\ton\tthe\tnature\tof\nthe\tdisorder\nHypoplastic\tbone\nmarrow\nAplastic\tanemia\nPure\tRBC\taplasia\nTransfusion\nAndrogens\nInfiltrated\tbone\nmarrow\nLeukemia,\tmultiple\tmyeloma,\nmyelofibrosis\nChemotherapy\nEndocrine\nabnormality
|
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] |
myelofibrosis\nChemotherapy\nEndocrine\nabnormality\nHypothyroidism,\tadrenal\ninsufficiency\nTreatment\tof\tunderlying\tdisease\nChronic\tdisease\nTreatment\tof\tunderlying\tdisease\nRenal\tdisease\nRenal\tdisease\nTreatment\tof\tunderlying\tdisease\nLiver\tdisease\nCirrhosis\nTreatment\tof\tunderlying\n\tdisease\nDNA,\n\tDeoxyribonucleic\tacid;\t\nMCHC,
|
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] |
Treatment\tof\tunderlying\n\tdisease\nDNA,\n\tDeoxyribonucleic\tacid;\t\nMCHC,\n\tmean\tcorpuscular\themoglobin\tconcentration:\tconcentration\tof\themoglobin\texpressed\tin\tgrams\tper\tdeciliter\n(g/dL);\t\nMCV,\n\tmean\tcorpuscular\tvolume:\tvolume\tof\tone\tred\tblood\tcell\texpressed\tin\tfemtoliters\t(fl);\t\nRBC\n,\tred\tblood\tcell.\nModified\tfrom\tWintrobe\tMM\tet\tal:
|
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] |
RBC\n,\tred\tblood\tcell.\nModified\tfrom\tWintrobe\tMM\tet\tal:\t\nClinical\thematology,\n\ted\t8,\tPhiladelphia,\t1981,\tLea\t&\tFebiger.\nMacrocytic\tanemia\n\tpresents\n\twith\tlarger-than-normal\tRBCs,\tplus\tincreased\tmean\tcorpuscular\nvolume\t(MCV)\tand\tmean\tcorpuscular\themoglobin\tconcentration\t(MCHC).\t\nMicrocytic\tanemia\n\tis
|
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] |
Microcytic\tanemia\n\tis\ncharacterized\tby\tsmaller-than-normal\terythrocytes\tand\tless\tcirculating\themoglobin,\tas\tin\tiron\ndeficiency\tanemia\tand\tthalassemia.\nMost\tanemias\tare\tcaused\tby\ta\tlack\tof\tnutrients\trequired\tfor\tnormal\terythrocyte\tsynthesis,\nprincipally\tiron,\tvitamin\tB\n12\n,\tand\tfolate.\tThese\tanemias\tthat\tresult\tfrom\tan\tinadequate\tintake\tof\tiron,
|
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] |
protein,\tcertain\tvitamins,\tcopper,\tand\tother\theavy\tmetals\tare\tcalled\t\nnutritional\tanemias\n.\tOther\nanemias\tresult\tfrom\tconditions\tsuch\tas\themorrhage,\tgenetic\tabnormalities,\tchronic\tdisease\tstates,
|
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0.11139281839132309,
0.07116764038801193,
0.095500148832798,
0.00009738521475810558
] |
have\ta\tgene\tfor\tpositive\tbalance\tand\tincreased\tstorage\tof\tiron,\tand\tapproximately\t1%\thave\tiron\noverload.\tAnemia\talso\taffects\tsome\tgroups\tmore\tthan\tothers.\tNon-Hispanic\tblacks\tand\tHispanics\nhave\tthe\thighest\tprevalence\tof\tanemia\n\tfollowed\tby\tnon-Hispanic\twhites.\tAs\tshown\tin\t\nFig.\t31.1\n,
|
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] |
followed\tby\tnon-Hispanic\twhites.\tAs\tshown\tin\t\nFig.\t31.1\n,\nstages\tof\tiron\tstatus\trange\tfrom\tiron\toverload\tto\tiron\tdeficiency\tanemia\tand\tare\tsummarized\tas\nfollows\t(\nHerbert,\t1992\n):\na.\t\nStage\tI\tand\tstage\tII\tnegative\tiron\tbalance\t(i.e.,\tiron\tdepletion).\tIn\tthese\tstages\tiron\tstores
|
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] |
are\tlow\tand\tthere\tis\tno\tdysfunction.\tIn\tstage\tI\tnegative\tiron\tbalance,\treduced\tiron\nabsorption\tproduces\tmoderately\tdepleted\n\tiron\tstores.\tStage\tII\tnegative\tiron\tbalance\tis\ncharacterized\tby\tseverely\tdepleted\tiron\tstores.\nb.\t\nStage\tIII\tand\tstage\tIV\tnegative\tiron\tbalance\t(i.e.,\tiron\tdeficiency).\tIron\tdeficiency\tis
|
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] |
characterized\tby\tinadequate\tbody\tiron,\tpossibly\tcausing\tdysfunction\tand\tdisease.\tIn\tstage\tIII\nnegative\tiron\tbalance,\tdysfunction\tis\tnot\taccompanied\tby\tanemia;\tanemia\tdevelops\tin\tstage\nIV\tnegative\tiron\tbalance.\nc.\t\nStage\tI\tand\tstage\tII\tpositive\tiron\tbalance.\tStage\tI\tpositive\tbalance\tusually\tlasts\tfor\tseveral
|
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years\twith\tno\tdysfunction.\tSupplements\tof\tiron\tand/or\tvitamin\tC\tpromote\tprogression\tto\ndysfunction\tor\tdisease,\twhereas\tiron\tremoval\tprevents\tprogression\tto\tdisease.\tIron\toverload\ndisease\tdevelops\tin\tpersons\twith\tstage\tII\tpositive\tbalance\tafter\tyears\tof\tiron\toverload\thave\ncaused\tprogressive\tdamage\n\tto\ttissues\tand\torgans.\nFIG.\t31.1
|
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0.069370336830616,
0.014408987015485764
] |
caused\tprogressive\tdamage\n\tto\ttissues\tand\torgans.\nFIG.\t31.1\nSequential\tstages\tof\tiron\tstatus.\t\nIBC\n,\tIron-binding\tcapacity;\t\nRBC\n,\tred\tblood\tcell;\t\nRE\n,\nreticuloendothelial\tcells.\n\tSource:\t(Copyright\tVictor\tHerbert,\t1995.)\nIron\tstatus\thas\ta\tvariety\tof\tindicators.\tSerum\t\nferritin\n\tis\tan\tiron\tapoferritin\tcomplex,\tone\tof\tthe
|
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0.03689175844192505
] |
ferritin\n\tis\tan\tiron\tapoferritin\tcomplex,\tone\tof\tthe\nchief\tstorage\tforms\tof\tiron.\tSerum\tferritin\tlevels\tare\tin\tequilibrium\twith\tbody\tiron\tstores.\tVery\tearly\n(stage\tI)\tpositive\tiron\n\tbalance\tmay\tbest\tbe\trecognized\tby\tmeasuring\t\ntotal\tiron-binding\tcapacity\n(TIBC)\n,\tthe\tcapacity\tof\ttransferrin\tto\ttake\ton\tor\tbecome\tsaturated\twith\tiron.\tConversely,
|
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measurement\tof\tserum\tor\tplasma\tferritin\tlevels\tmay\tbest\treveal\tearly\t(stages\tI\tor\tII)\tnegative\tiron\nbalance,\talthough\tserum\tTIBC\tmay\tbe\tas\tgood\tan\tindicator\t(see\t\nChapter\t5\n).\t\nTransferrin\tsaturation\nis\tthe\tmeasure\tof\tthe\tamount\tof\tiron\n\tbound\tto\ttransferrin\tand\tis\ta\tgauge\tof\tiron\tsupply\tto\tthe\ttissues;
|
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0.03238895907998085,
0.057715900242328644,
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0.07937611639499664,
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0.15069879591464996,
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0.0045079453848302364,
0.0168322641402483,
0.07834817469120026,
0.06655163317918777,
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0.07325949519872665,
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0.0026951555628329515,
0.11357678472995758,
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0.04359719902276993,
0.07142726331949234,
0.03169886767864227,
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0.020634116604924202,
0.03553491830825806,
0.05645741894841194,
0.023052068427205086,
-0.014035026542842388
] |
bound\tto\ttransferrin\tand\tis\ta\tgauge\tof\tiron\tsupply\tto\tthe\ttissues;\nthe\tpercent\tsaturation\t=\tserum\tiron/TIBC\t×\t100.\nIron\tdeficiency\tanemia\nPathophysiology\nIron\tdeficiency\tanemia\n\tis\tcharacterized\tby\tthe\tproduction\tof\tmicrocytic\terythrocytes\tand\ta
|
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0.0017735690344125032,
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0.002229644451290369,
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0.05648685619235039,
0.0633787140250206,
0.013884066604077816,
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0.020528532564640045,
0.12700043618679047,
0.056728191673755646,
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] |
diminished\tlevel\tof\tcirculating\themoglobin.\tThis\tmicrocytic\tanemia\tis\tthe\tlast\tstage\tof\tiron\ndeficiency,\tand\tit\trepresents\tthe\tend\tpoint\tof\ta\tlong\n\tperiod\tof\tiron\tdeprivation.\tThere\tare\tmany\ncauses\tof\tiron\tdeficiency\tanemia\tas\tdiscussed\tin\t\nBox\t31.1\n.\nBOX\t31.1\nCauses\tof\tIron\tDeficiency\tAnemia\nInadeq\nuate\nInge\nstion
|
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] |
.\nBOX\t31.1\nCauses\tof\tIron\tDeficiency\tAnemia\nInadeq\nuate\nInge\nstion\nPoor\tdiet\twithout\tsupplementation\tof\tiron\nInadeq\nuate\nAbso\nrptio\nn\nDiarrhea,\tachlorhydria,\tintestinal\tdisease\tsuch\tas\tceliac\tdisease,\tatrophic\tgastritis,\tpartial\tor\ntotal\tgastrectomy,\tor\tdrug\tinterference\nInadeq\nuate\nUtili\nzatio\nn\nChronic\tgastrointestinal\tdisturbances\nIncreas\ned\nReq
|
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] |
Utili\nzatio\nn\nChronic\tgastrointestinal\tdisturbances\nIncreas\ned\nReq\nuire\nment\nIncrease\tof\tblood\tvolume,\twhich\toccurs\tduring\tinfancy,\tadolescence,\tpregnancy,\tand\tlactation\nand\twhich\tis\tnot\tbeing\tmatched\twith\tintake\nIncreas\ned\nExcr\netion\nExcessive\tmenstrual\tblood\t(in\tfemales);\themorrhage\tfrom\tinjury;\tor\tchronic\tblood\tloss\tfrom\ta
|
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] |
bleeding\tulcer,\tbleeding\themorrhoids,\tesophageal\tvarices,\tregional\tenteritis,\tceliac\n\tdisease,\nCrohn’s\tdisease,\tulcerative\tcolitis,\tparasitic\tor\tmalignant\tdisease\nIncreas\ned\nDest\nructi\non\nCaused\tby\ta\tchronic\tinflammation\tor\tother\tchronic\tdisorder\tleading\tto\tdestruction\tof\tRBC’s
|
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] |
A\tcommon\tcause\tof\tiron\tdeficiency\tis\tblood\tloss,\teither\tchronic\tor\tacute,\tincluding\theavy\tmenstrual\nbleeding\tin\twomen.\tIt\tcan\talso\tbe\tcaused\tby\tmalabsorption,\tmedications,\tand\tinadequate\tintake.\nBecause\tanemia\tis\tthe\tlast\tmanifestation\tof\tchronic,\tlong-term\tiron\tdeficiency,\tthe\tsymptoms\treflect
|
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] |
a\tmalfunction\tof\ta\tvariety\tof\tbody\tsystems.\tInadequate\tmuscle\tfunction\tis\treflected\tin\tdecreased\nwork\tperformance\tand\texercise\ttolerance.\tNeurologic\tinvolvement\tis\tmanifested\tby\tbehavioral\nchanges\tsuch\tas\tfatigue,\tanorexia,\tand\t\npica\n\t(consumption\tof\tnonfood\titems),\tespecially\t\npagophagia\n(ice\teating).
|
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(consumption\tof\tnonfood\titems),\tespecially\t\npagophagia\n(ice\teating).\n\tAbnormal\tcognitive\tdevelopment\tin\tchildren\tmay\tindicate\tiron\tdeficiency\tbefore\tit\thas\ndeveloped\tinto\tovert\tanemia\t(\nJáuregui-Lobera,\t2014\n).\nGrowth\tabnormalities,\tepithelial\tdisorders,\tand\ta\treduction\tin\tgastric\tacidity\tare\talso\tcommon.\tA
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possible\tsign\tof\tearly\tiron\tdeficiency\tis\treduced\timmunocompetence,\tparticularly\tdefects\tin\tcell-\nmediated\timmunity\tand\tthe\tphagocytic\tactivity\tof\tneutrophils,\n\twhich\tmay\tlead\tto\tfrequent\tinfections.\nRestless\tlegs\tsyndrome\t(RLS)\n\twith\tleg\tpain\tor\tdiscomfort\tmay\tresult\tfrom\ta\tlack\tof\tiron\tin\tthe\nbrain;\tthis\talters\tdopamine\tproduction\tand\tmovement\t(
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brain;\tthis\talters\tdopamine\tproduction\tand\tmovement\t(\nConnor\tet\tal,\t2017\n).\nAs\tiron\tdeficiency\tanemia\tbecomes\tmore\tsevere,\tdefects\tarise\tin\tthe\tstructure\tand\tfunction\tof\tthe\nepithelial\ttissues,\tespecially\tof\tthe\ttongue,\tnails,\tmouth,\tand\tstomach.\tThe\tskin\tmay\tappear\n\tpale\tin
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] |
pale\tin\npeople\twith\tlighter\tcomplexions,\tand\tthe\tinside\tof\tthe\tlower\teyelid\tmay\tbe\tlight\tpink\tinstead\tof\tred\nregardless\tof\tskin\ttone.\tMouth\tchanges\tinclude\tatrophy\tof\tthe\tlingual\tpapillae,\tburning,\tredness,\tand\nin\tsevere\tcases,\t\nglossitis\n,\ta\tcompletely\tsmooth,\twaxy,\tand\tglistening\tappearance\tof\tthe\ttongue.
|
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] |
,\ta\tcompletely\tsmooth,\twaxy,\tand\tglistening\tappearance\tof\tthe\ttongue.\nAngular\tstomatitis\tand\ta\tform\tof\tdysphagia\tmay\toccur.\tGastritis\toccurs\tfrequently\tand\tmay\n\tresult\tin\nachlorhydria\t(low\tstomach\tacid).\tFingernails\tcan\tbecome\tthin\tand\tflat,\tand\teventually\t\nkoilonychia\n(spoon-shaped\tnails)\tmay\tbe\tnoted\t(\nFig.\t31.2\n).
|
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] |
FIG.\t31.2\nFingernails\twith\tcup-like\tdepressions\t(koilonychia)\tare\ta\tsign\tof\tiron\tdeficiency\tin\tadults.\n\tSource:\t(From\nHeitz\tC.\tKoilonychia.\tIn:\tFlickr\t[website].\t\t\nhttps://www.flickr.com/photos/coreyheitzmd/15023020192\n.\tApril\t14,\t2014.)\nProgressive,\tuntreated\tanemia\tresults\tin\tcardiovascular\tand\trespiratory\tchanges\tthat\tcan
|
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] |
eventually\tlead\tto\tcardiac\tfailure.\tSome\tsocial\tand\temotional\tbehavioral\n\tsymptoms\trespond\tto\tiron\ntherapy\tbefore\tthe\tanemia\tis\tcured,\tsuggesting\tthey\tmay\tbe\tthe\tresult\tof\ttissue\tdepletion\tof\tiron-\ncontaining\tenzymes\trather\tthan\ta\tdecreased\tlevel\tof\themoglobin\t(\nsee\n\t\nPathophysiology\tand\tCare\nManagement\tAlgorithm:\n\tIron\tDeficiency\tAnemia\n).
|
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] |
Management\tAlgorithm:\n\tIron\tDeficiency\tAnemia\n).\nAssessment\nA\tdefinitive\tdiagnosis\tof\tiron\tdeficiency\tanemia\trequires\tmore\tthan\tone\tmethod\tof\tiron\tevaluation;\nserum\tferritin,\tiron,\tand\ttransferrin\tare\tthe\tmost\tuseful.\tThe\tevaluation\talso\tshould\tinclude\tan
|
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assessment\tof\tcell\tsize\tand\tshape\t(morphology).\tBy\titself,\themoglobin\tconcentration\tis\tunsuitable\tas\na\tdiagnostic\ttool\tin\tcases\tof\tsuspected\tiron\tdeficiency\tanemia\tfor\tthree\treasons:\n\t(1)\tit\tis\taffected\tonly\nlate\tin\tthe\tdisease,\t(2)\tit\tcannot\tdistinguish\tiron\tdeficiency\tfrom\tother\tanemias,\tand\t(3)\themoglobin
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0.0856616422533989,
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0.0814819261431694,
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0.06656380742788315,
0.08993654698133469,
0.03334607556462288,
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0.012195577844977379,
0.07512836158275604,
0.12771989405155182,
0.06885524839162827,
-0.06520524621009827
] |
values\tmay\tbe\twithin\tthe\tnormal\trange\tdespite\tiron\tdeficiency.\nAfter\tabsorption,\tiron\tis\ttransported\tby\tplasma\t\ntransferrin\n—a\tbeta-1\tglobulin\t(protein)\tthat\tbinds\niron\tderived\tfrom\tthe\tgastrointestinal\ttract,\tiron\tstorage\tsites,\tor\themoglobin\tbreakdown—to\tthe\nbone\tmarrow
|
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] |
bone\tmarrow\n\t(hemoglobin\tsynthesis),\tendothelial\tcells\t(storage),\tor\tplacenta\t(fetal\tneeds).
|
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] |
Transferrin\tmolecules\tare\tgenerated\ton\tthe\tsurface\tof\tRBCs\tin\tresponse\tto\tthe\tneed\tfor\tiron.\tWith\niron\tdeficiency,\tso\tmany\t\ntransferrin\treceptors\n\tare\ton\tthe\tcell\tsurface\tunbound\tto\tiron\tthat\tsome\tof\nthem\tbreak\toff\tand\tfloat\tin\tthe\tserum.\tTheir\tpresence\tis\tan\tearly\tsign\tof\tdeveloping\tiron\tdeficiency;\ta\nhigher\tquantity\n\tof
|
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] |
higher\tquantity\n\tof\t\nsoluble\tserum\ttransferrin\treceptors\t(STFRs)\n\tmeans\tgreater\tdeficiency\tof\tiron.\nProgressive\tstages\tof\tiron\tdeficiency\tcan\tbe\tevaluated\tby\tmeasurements,\tas\tshown\tin\t\nTable\t31.2\n.\nTABLE\t31.2\nBiochemical\tEvaluation\tof\tIron\tDeficiency\nMeasure\nReference\nRange\nDeficiency\nSerum\tor\nplasma\nferritin\nNewborn\t25-200\nng/mL;\t25-\n200\tmcg/dL
|
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] |
Serum\tor\nplasma\nferritin\nNewborn\t25-200\nng/mL;\t25-\n200\tmcg/dL\nNeonate\t–\t5\nmos\n50-200\nng/mL;\n50-200\nmcg/dL\n6\tmos-15\tyr\n7-142\nng/mL;\t7-\n142\nmcg/dL\nF\t15\tyr\t+\t10-\n150\nng/mL;\n10-150\nmcg/dL\nM\t15\tyr\t+\n12-300\nng/mL;\n12-300\nmcg/dL\nThe\tmost\tsensitive\tindicator\tof\tiron\tdeficiency.\tLow\tlevels\tof\tferritin\nare\talso\tseen\tin\tsevere\tprotein\tdepletion.
|
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0.07994120568037033,
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-0.006127763073891401,
-0.013538953848183155,
0.01787910982966423,
0.019736789166927338,
0.031498055905103683,
0.02757614478468895,
0.0004967026761732996,
0.06032288447022438,
0.030097506940364838,
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-0.07671767473220825,
0.0166483111679554,
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0.06258762627840042,
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0.08119513094425201,
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0.018630871549248695,
-0.02451598271727562,
-0.002135320333763957,
0.02380877546966076,
0.010242548771202564,
0.048523422330617905,
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-0.041409313678741455,
0.0024558459408581257,
-0.007816226221621037,
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0.05171913281083107,
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0.12140262126922607,
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0.04897035285830498,
0.12408249825239182,
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-0.04658371955156326,
0.06090351566672325,
0.0008924768189899623,
-0.050918467342853546,
-0.0005538667319342494,
0.05323571711778641,
-0.016232958063483238,
-0.03728637099266052,
-0.1103903278708458,
-0.016846882179379463,
-0.01708056963980198,
0.03286847472190857,
0.030045202001929283,
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0.017599215731024742,
0.013520411215722561,
0.040847085416316986,
-0.029179144650697708
] |
are\talso\tseen\tin\tsevere\tprotein\tdepletion.\nFemales\t–\t<\t10\tmcg/dL\nMales\t–\t<\t12\tmcg/dL\nSerum\tor\nplasma\tiron\nF\t40-150\nmcg/dL;\t7.2-\n26.9\tmmol/L\nM\t50-160\nmcg/dL;\n8.9-28.7\nmmol/L\nA\tgood\tmeasure\tof\tquantity\tof\tiron\tbound\tto\ttransferrin.\nFemales\t–\t<\t40\tmcg/dL\nMales\t–\t<50\tmcg/dL\nTotal\tiron-\nbinding\ncapacity\n(TIBC)\n250-460\tmcg/dL;\n45-82\tmmol/L
|
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4.811310132859131e-33,
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0.035686053335666656,
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0.006719515658915043,
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0.03619809448719025,
0.008130225352942944,
0.00993157085031271,
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0.049582675099372864,
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0.028938939794898033,
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0.029230162501335144,
0.02901545539498329,
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0.07167471945285797,
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0.08967646956443787,
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0.002275957027450204,
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0.029904380440711975,
0.005662631709128618,
0.02982260286808014,
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0.006441797129809856,
0.006169337313622236,
0.041636500507593155,
0.05202470347285271,
0.09900540113449097,
0.04216211289167404,
0.11130417883396149,
0.1007600948214531,
0.10099196434020996,
0.040359675884246826,
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-0.025827646255493164,
0.021105578169226646,
-0.028682881966233253,
0.004479854367673397,
0.0026704201009124517,
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0.02640070579946041,
0.02712356112897396,
0.009043673053383827,
-0.03416895866394043,
0.10311953723430634,
-0.007795779965817928,
-0.0728776603937149,
-0.0368754006922245,
0.011753314174711704,
-0.014133058488368988,
-0.07872430235147476,
0.09021063148975372,
-0.020904870703816414,
-0.06936421990394592,
0.007264592684805393,
0.04979759082198143,
0.051173266023397446,
0.02076118066906929,
0.007124550174921751,
-0.05345157906413078,
-0.08853857219219208,
-0.027315793558955193,
0.017454219982028008,
0.04605266824364662,
-0.00454985536634922,
-0.060130663216114044,
0.014387397095561028,
0.025344563648104668,
0.01104857586324215,
0.0012875576503574848,
-0.06610909104347229,
0.00622093491256237,
-0.009476128965616226,
0.1426953673362732,
-0.003519912716001272,
-0.04473571479320526,
-0.047275397926568985,
0.068695068359375,
0.09948679059743881,
-0.05310337245464325,
-0.06755606830120087,
0.050236400216817856,
-0.003545904066413641,
-0.013573388569056988,
0.01206300314515829,
0.09134051948785782,
0.017397422343492508,
-0.04024498537182808,
-0.02761721797287464,
-0.008382251486182213,
-0.07912253588438034,
0.027561809867620468,
0.0035066097043454647,
0.04245837405323982,
-0.05365375801920891,
0.033392392098903656,
0.029755961149930954,
-0.05298107862472534
] |
Total\tiron-\nbinding\ncapacity\n(TIBC)\n250-460\tmcg/dL;\n45-82\tmmol/L\nTIBC\tprimarily\treflects\tliver\tfunction\tand\tis\tan\tindirect\tmeasurement\nof\ttransferrin.\nIncreases\twith\tiron-deficiency\tanemia.\nTransferrin\nsaturation\nF\t15%-50%\nM\t20%-50%\nMeasures\tthe\tiron\tsupply\tto\tthe\ttissues.\nCalculated\tby\tdividing\tserum\tiron\tby\tthe\tTIBC\tmultiplied\tby\t100.
|
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0.08027627319097519,
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0.11779438704252243,
0.046102505177259445,
0.07675842195749283,
0.0124670946970582,
0.06680744886398315,
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0.11359991878271103,
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0.007633809931576252,
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] |
Calculated\tby\tdividing\tserum\tiron\tby\tthe\tTIBC\tmultiplied\tby\t100.\nLevels\tless\n\tthan\t16%\tare\tconsidered\tinadequate\tfor\terythropoiesis.\nSoluble\tserum\ntransferrin\nreceptor\n(STFR)\nF\t1.9-4.4\tmg/L\nM\t2.2-5\tmg/L\nSTFR\treflects\tthe\trate\tof\tred\tblood\tcell\t(RBC)\tproduction\tin\tbone\nmarrow.\tOrdered\tto\tdifferentiate\tbetween\tiron\tdeficiency\tanemia
|
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] |
marrow.\tOrdered\tto\tdifferentiate\tbetween\tiron\tdeficiency\tanemia\nand\tanemia\tof\tchronic\tdisease.\nMore\tsensitive\tthan\tserum\tferritin\tbecause\tit\tis\televated\twith\tiron\ndeficiency,\tis\twithin\tnormal\tlimits\t(WNL)\n\tin\tchronic\tdisease\tor\ninflammation,\tand\tis\tlow\twith\tiron\toverload.\nCreated\twith\tassistance\tby\tMary\tLitchford,\tPhD,\tRDN,\tLDN.\nProtoporphyrin
|
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] |
Protoporphyrin\n\tis\tthe\tiron-containing\tportion\tof\tthe\trespiratory\tpigments\tthat\tcombines\twith\nprotein\tto\tform\themoglobin\tor\tmyoglobin.\tThe\tzinc\tprotoporphyrin\t(ZnPP)/heme\tratio\tis\tmeasured\tto\nassess\tiron\tdeficiency.\tHowever,\tboth\tthis\tZnPP/heme\tratio\tand\themoglobin\n\tlevels\tare\taffected\tby
|
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] |
levels\tare\taffected\tby\nchronic\tinfection\tand\tother\tfactors\tthat\tcan\tproduce\ta\tcondition\tthat\tmimics\tiron\tdeficiency\tanemia\nwhen,\tin\tfact,\tiron\tis\tadequate.\nAt\thigher\taltitudes,\twhere\tthere\tis\ta\tlower\tavailability\tof\toxygen,\thematocrit\tand\themoglobin\tlevels\nincrease\tto\tadapt\t(\nRyan\tet\tal,\t2014
|
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] |
increase\tto\tadapt\t(\nRyan\tet\tal,\t2014\n).\tThis\tmust\tbe\tconsidered\twhen\tassessing\tanemia.\tHigh\taltitude\nis\t4900\tto\t11,500\tfeet;\tvery\thigh\taltitude\n\tis\t11,500\tto\t18,000\tfeet;\textreme\taltitude\tis\tabove\t18,000\nfeet.\nMedical\tmanagement\nTreatment\tof\tiron\tdeficiency\tanemia\tshould\tfocus\tprimarily\ton\tthe\tunderlying\tcause,\talthough\tthis\tis
|
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] |
often\tdifficult\tto\tdetermine.\tThe\tgoal\tis\trepletion\tof\tiron\tstores.\nOral\tsupplementation.\nThe\tchief\ttreatment\tfor\tiron\tdeficiency\tanemia\tinvolves\toral\tadministration\tof\tinorganic\tiron\tin\tthe\nferrous\tform.\n\tAlthough\tthe\tbody\tuses\tferric\tand\tferrous\tiron,\tthe\treduced\tferrous\tis\teasier\ton\tthe\tgut
|
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] |
and\tbetter\tabsorbed.\tAt\ta\tdose\tof\t30\tmg,\tabsorption\tof\tferrous\tiron\tis\tthree\ttimes\tgreater\tthan\tif\tthe
|
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same\tamount\twere\tgiven\tin\tthe\tferric\tform.\nIron\tis\tbest\tabsorbed\twhen\tthe\tstomach\tis\tempty.\tHowever,\tunder\tthese\tconditions\tit\ttends\tto\ncause\tgastric\tirritation,\twhich\tis\ta\tdirect\tresult\tof\tthe\thigh\tquantity\n\tof\tfree\tferrous\tiron\tin\tthe\nstomach.\tGastrointestinal\tside\teffects\tcan\tinclude\tnausea,\tepigastric\tdiscomfort\tand\tdistention,
|
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heartburn,\tdiarrhea,\tor\tconstipation.\tIf\tthese\tside\teffects\toccur,\tthe\tpatient\tis\ttold\tto\ttake\tthe\tiron\nwith\tmeals\tinstead\tof\ton\tan\tempty\tstomach;\thowever,\tthis\tsharply\treduces\tthe\tabsorbability\tof\tthe\niron.\tChelated\tforms\tof\tiron\t(combined\twith\tamino\tacids\tor\tKrebs\tcycle\n\tintermediaries)\tare\tmore
|
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0.10723177343606949,
0.07094153761863708,
0.08956427127122879,
-0.003063443349674344
] |
intermediaries)\tare\tmore\nbioavailable\tthan\tnonchelated\tiron.\tChelated\tiron\tis\tless\taffected\tby\tinhibitors\tof\tiron\tabsorption,\nincluding\tphytate,\toxalate,\tphosphate,\tand\tcalcium.\tChelated\tiron,\tparticularly\tferrous\tbis\tglycinate,\ncauses\tless\tgastrointestinal\tdisturbances\tthan\telemental\tiron\tand\tit\tcan\tbe\tgiven\tin\ta\tlower\tdose\n(\nFerrari\tet\tal,\t2012
|
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0.10707979649305344,
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0.06052623689174652,
0.0765749141573906,
0.10636124759912491,
-0.04264746978878975
] |
(\nFerrari\tet\tal,\t2012\n;\t\nMilman\tet\tal,\t2013\n).\tMicronutrient\tpowders\t(MNPs)\n\tcontaining\tiron\tmay\tbe\nuseful\tmethods\tof\thome\tfood\tfortification\tfor\tchildren\tunder\tage\t2\t(\nDe-Regil\tet\tal,\t2013\n).\tThe\tMNPs\ncan\tbe\tadded\tto\tsemisolid\tfoods\twithout\taffecting\tthe\tsensory\tappeal\tof\tthe\tfoods.\tVarious\tforms\tof\niron\tsupplements\tare\tdiscussed\tin\t\nTable\t31.3\n.
|
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-0.027691030874848366,
-0.06359412521123886,
0.04242587462067604,
0.006521100644022226,
0.0820685401558876,
-0.01601690612733364,
-0.003412851830944419,
0.031159786507487297,
0.0018227195832878351,
0.0004093479074072093,
-0.02646803855895996,
-0.005169741343706846,
-0.028716279193758965,
0.05753134936094284,
-0.012908725067973137,
-0.05490977689623833,
-0.00004517169145401567,
-0.008181236684322357,
0.01508354302495718,
0.0005626330384984612,
0.07651551812887192,
-0.015428557060658932,
0.0720292255282402,
0.013135302811861038,
-0.07605402171611786,
0.05613119527697563,
0.004135378170758486,
-0.09286634624004364,
-0.05140524357557297,
0.06190483272075653,
0.013326629064977169,
-0.019639011472463608,
0.032622262835502625,
0.04740893095731735,
0.006979729514569044,
0.07308060675859451,
0.004528909921646118,
0.03781542554497719,
-0.0563691109418869,
0.017769278958439827,
-0.06512444466352463,
-0.021555816754698753,
-0.05090522766113281,
-0.003469947725534439,
-0.029081914573907852,
-0.046442631632089615,
-0.02631271630525589,
0.02302311733365059,
-0.08905618637800217,
0.019725263118743896,
-0.0002049725007964298,
-0.03532261401414871,
0.03590768948197365,
-0.01039843074977398,
-0.0590328611433506,
-0.08285846561193466,
-3.028475870862377e-33,
-0.029459567740559578,
-0.01808318682014942,
-0.026968488469719887,
0.008933636359870434,
-0.037861213088035583,
-0.08054330199956894,
-0.008439787663519382,
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0.09791046380996704,
-0.019236041232943535,
0.062148820608854294,
0.0072162761352956295,
-0.011864504776895046,
-0.1194634661078453,
-0.03594629094004631,
0.04179548844695091,
0.02366778627038002,
0.09741796553134918,
-0.01648729480803013,
-0.05192543938755989,
-0.08041699230670929,
0.05348314717411995,
-0.0794709324836731,
0.1041683480143547,
-0.0010058763436973095,
0.06904114037752151,
0.005002064164727926,
0.023068059235811234,
0.029651327058672905,
0.01625082455575466,
0.018644869327545166,
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0.07411743700504303,
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0.03454751893877983,
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0.012176305055618286,
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0.03336118161678314,
-0.04566149786114693,
-0.12943430244922638,
0.06202225759625435,
-0.052622903138399124,
0.042225416749715805,
-0.014117415994405746,
-0.004502193070948124,
-0.029829053208231926,
-0.07396551966667175,
-0.022010648623108864,
0.06116694211959839,
0.021295495331287384,
-0.03046538680791855,
-0.04120814427733421,
0.060743022710084915,
0.06934323161840439,
0.04971736669540405,
0.07553841173648834,
0.004428267013281584,
0.06735125184059143,
0.07974829524755478,
0.09950729459524155,
0.09864405542612076,
-5.437338401748093e-8,
-0.006554447580128908,
-0.0933438241481781,
-0.023477662354707718,
0.034623973071575165,
0.09069196879863739,
-0.028807053342461586,
0.03306709602475166,
0.013726315461099148,
0.004729379899799824,
-0.02817394770681858,
0.05213629826903343,
0.08834106475114822,
-0.08099132776260376,
-0.056152764707803726,
0.08773741871118546,
-0.03428660333156586,
0.006753131747245789,
0.07212018221616745,
-0.041838422417640686,
-0.06315692514181137,
-0.010326428338885307,
0.08155983686447144,
-0.03868279978632927,
-0.007066498044878244,
-0.012376883998513222,
0.01954275369644165,
-0.040725819766521454,
-0.01197504810988903,
0.05147719010710716,
0.05316139757633209,
0.060159824788570404,
-0.05127860605716705,
-0.020844368264079094,
-0.029269928112626076,
0.00597219355404377,
0.04826010763645172,
-0.08671620488166809,
-0.02984919771552086,
-0.03185904026031494,
0.12098637223243713,
-0.027783486992120743,
-0.027548110112547874,
-0.028654919937253,
0.08639545738697052,
0.04323715344071388,
-0.042045269161462784,
-0.08373519033193588,
0.09881920367479324,
0.0008732943679206073,
-0.04370000213384628,
-0.0069526489824056625,
0.06530589610338211,
0.036158960312604904,
-0.030174920335412025,
-0.023237207904458046,
-0.007753095589578152,
0.06434445083141327,
-0.009992288425564766,
0.04909249395132065,
0.042007096111774445,
0.05179852619767189,
0.08105523139238358,
0.0641857162117958,
-0.02143336646258831
] |
iron\tsupplements\tare\tdiscussed\tin\t\nTable\t31.3\n.\nTABLE\t31.3\nForms\tof\tIron\tSupplements\nIron\tSupplement\nAdvantages\nDisadvantages\nFerrous\tsulfate\nMost\tcommonly\tstudied\nLeast\texpensive\nMost\tconstipating\nFerrous\tgluconate\nGenerally\twell\ttolerated\twith\nfew\tgastrointestinal\tside\neffects\nCarbonyl\tiron\t(slow\tiron)\nGenerally\twell\ttolerated\twith
|
[
-0.010333011858165264,
-0.09681373834609985,
0.021206839010119438,
0.08489187806844711,
-0.040568575263023376,
0.026022575795650482,
0.07227471470832825,
0.006405618507415056,
-0.08604540675878525,
0.04939470440149307,
0.025625722482800484,
-0.0000797856118879281,
0.002007139613851905,
0.008628311567008495,
-0.052977364510297775,
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0.06477205455303192,
-0.005117554683238268,
-0.04296913743019104,
0.027535121887922287,
0.01210763305425644,
0.036514103412628174,
0.07608255743980408,
-0.004863530397415161,
-0.005292292218655348,
0.04861655458807945,
-0.055480875074863434,
-0.014547702856361866,
-0.011302953585982323,
-0.05721335858106613,
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0.03302847594022751,
0.044136445969343185,
-0.042355794459581375,
0.03614604100584984,
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0.01913192681968212,
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0.046138279139995575,
0.03728196397423744,
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0.059810273349285126,
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-0.033665891736745834,
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0.08747590333223343,
0.06848903745412827,
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-0.06375516206026077,
-0.0767897441983223,
-0.004543558228760958,
-0.02537013217806816,
-0.046924129128456116,
-0.053495246917009354,
-0.008137914352118969,
-0.0024833546485751867,
0.10240583121776581,
-0.01680794544517994,
-0.018382173031568527,
-0.006808801554143429,
0.07274936884641647,
-0.01437344215810299,
0.036443691700696945,
-0.06844821572303772,
0.10070011764764786,
0.022742122411727905,
0.028396470472216606,
0.13113100826740265,
-0.08312857151031494,
0.017050668597221375,
0.000319873244734481,
-0.11059104651212692,
0.07663010060787201,
-0.006457395851612091,
0.041971370577812195,
-0.0022527810651808977,
0.0218290314078331,
-0.03744640201330185,
0.045132845640182495,
-0.020572690293192863,
-0.009625297971069813,
0.030650123953819275,
-0.03265271335840225,
0.034847162663936615,
-0.07782605290412903,
-0.001839456264860928,
0.02368924580514431,
-0.005303098354488611,
-0.07348235696554184,
-0.009189778007566929,
-0.028678573668003082,
-0.011892929673194885,
0.025131888687610626,
0.006184326950460672,
0.02351541444659233,
-0.04504818469285965,
-0.009685207158327103,
0.02403389848768711,
0.00139757024589926,
0.02546386420726776,
0.02917860448360443,
-0.013701745308935642,
-0.01353068370372057,
0.02641463465988636,
-0.029514309018850327,
-0.03281893581151962,
-0.03100467287003994,
-0.00874167587608099,
-0.02062203176319599,
0.12495635449886322,
0.05454638972878456,
0.0378703847527504,
-0.01587950438261032,
0.04938586428761482,
-0.006984753999859095,
-0.04783701151609421,
-0.03319459408521652,
-0.03092757798731327,
2.9789094985210243e-33,
0.030268942937254906,
0.06272456794977188,
0.033595066517591476,
0.045514874160289764,
0.0018021013820543885,
-0.026074379682540894,
-0.06634094566106796,
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0.007667612750083208,
0.0737961009144783,
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0.0526268370449543,
0.001182400155812502,
0.08586642146110535,
0.015791606158018112,
-0.10477408766746521,
-0.023548219352960587,
0.08068067580461502,
0.007363710552453995,
-0.01915556937456131,
-0.008959216997027397,
0.10557618737220764,
0.051231179386377335,
-0.038198571652173996,
-0.015050878748297691,
-0.02154199592769146,
-0.07175949215888977,
0.00637201638892293,
-0.04727805405855179,
0.004418402910232544,
0.010608705691993237,
-0.04822830110788345,
-0.037277474999427795,
-0.025044187903404236,
-0.03447559475898743,
-0.026638008654117584,
-0.05880468338727951,
0.0012374453945085406,
0.06340432167053223,
-0.028471749275922775,
-0.02157546952366829,
0.07146505266427994,
-0.0035327989608049393,
0.07574080675840378,
0.056149840354919434,
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0.024127556011080742,
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-0.013735068030655384,
-0.005776801146566868,
0.009261471219360828,
0.0701209232211113,
-0.036069728434085846,
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0.0288483127951622,
0.006655173376202583,
0.060447826981544495,
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0.1424764096736908,
0.01799853891134262,
0.0746285617351532,
0.046395059674978256,
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0.016019975766539574,
0.02451799437403679,
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0.017116041854023933,
0.02343073859810829,
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0.004584284964948893,
0.02472740225493908,
0.014611953869462013,
0.08819721639156342,
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-0.036271873861551285,
0.0043086158111691475,
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0.0005586608895100653,
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0.049752190709114075,
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0.03477604687213898,
0.005204005632549524,
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-4.3194278278354065e-33,
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0.0017806637333706021,
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0.04278375953435898,
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0.07158000767230988,
0.009689358994364738,
0.10366080701351166,
0.0736224576830864,
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0.09104803949594498,
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0.07663767784833908,
0.05977815017104149,
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-0.022932514548301697,
0.05082504823803902,
-0.09970231354236603,
0.01908242329955101,
0.022434091195464134,
0.06830915063619614,
-0.047350574284791946,
-0.05941884219646454,
0.0822293758392334,
0.05930263176560402,
0.024372410029172897,
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0.018871720880270004,
0.021411055698990822,
0.015587642788887024,
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0.03604377806186676,
0.007471795193850994,
0.07241827249526978,
0.08305471390485764,
0.05194228142499924,
-0.0374751053750515,
-0.07747955620288849,
-0.05661223083734512,
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0.09230351448059082,
0.05698150396347046,
-0.01561598852276802,
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0.05327668786048889,
0.018270863220095634,
0.0018689302960410714,
0.019136210903525352,
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0.004148874897509813,
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0.023658689111471176,
0.07492353022098541,
0.0030048112384974957,
0.08230552077293396,
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-0.04575665295124054,
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-0.008811508305370808,
0.02493203803896904,
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-0.1582053154706955,
0.06250423938035965,
-0.025893304497003555,
0.07861418277025223,
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0.013967792503535748,
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0.005945014301687479,
0.010304022580385208,
-0.048789169639348984,
-0.002730380045250058,
-0.023414915427565575,
0.00658862479031086,
0.011678793467581272,
0.045730818063020706,
-0.019130609929561615,
-0.005018109921365976,
0.01877766288816929,
0.05072702839970589,
0.028234675526618958,
-4.721926671891197e-8,
0.024844175204634666,
-0.026243962347507477,
-0.0017576375976204872,
0.006333401892334223,
0.0032209225464612246,
-0.04059644788503647,
-0.00039241742342710495,
0.03337915241718292,
-0.03270778805017471,
-0.005790214519947767,
0.04740475118160248,
0.11936482042074203,
-0.04418230056762695,
-0.022956356406211853,
0.06069520115852356,
0.025865396484732628,
-0.0011216638376936316,
0.10813653469085693,
-0.03247738629579544,
-0.023812448605895042,
0.008754820562899113,
0.0450521744787693,
-0.005551143549382687,
0.0054561379365623,
-0.05237656086683273,
-0.034616030752658844,
-0.029267389327287674,
-0.02978689968585968,
0.034272294491529465,
0.07182153314352036,
0.054669804871082306,
-0.024745207279920578,
0.00503821624442935,
-0.03203659504652023,
-0.015402328222990036,
0.013327515684068203,
-0.044969405978918076,
-0.006361452862620354,
-0.040350597351789474,
0.12075453251600266,
-0.045063599944114685,
-0.025334281846880913,
-0.05855072662234306,
0.07956850528717041,
0.0680023580789566,
-0.06216686591506004,
-0.09914488345384598,
0.0664442926645279,
0.019750971347093582,
-0.05300792306661606,
-0.0024372816551476717,
0.08530782163143158,
0.022942733019590378,
-0.05873916670680046,
-0.04406183958053589,
0.11968230456113815,
0.0494731068611145,
0.004088155459612608,
0.005927585065364838,
0.01801227405667305,
0.08682525157928467,
0.0218936987221241,
0.07369860261678696,
-0.030985556542873383
] |
effects\nCarbonyl\tiron\t(slow\tiron)\nGenerally\twell\ttolerated\twith\nfew\tgastrointestinal\tside\neffects\nSlow\trate\tof\tsolubilization,\nwhich\tslows\tthe\trate\tof\nabsorption\nChelated\tiron\t(ferrous\tfumarate,\nsuccinate,\taspartate,\tand\tbis\nglycinate)\nBetter\tabsorbed\nFewer\tside\teffects\nLeast\tconstipating\nMore\texpensive
|
[
0.0033302009105682373,
-0.10566768050193787,
0.036983832716941833,
0.02039366401731968,
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