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12\n-responsive\nneurologic\n\tdisorders;\tpatients\twith\tunexplained\tleukoencephalopathy\tshould\tbe\ttreated\tproactively\nbecause\teven\tlong-standing\tdeficits\tmay\tbe\treversible\t(\nGraber\tet\tal,\t2010\n).\nStage\t1:\tEarly\tnegative\tvitamin\tB\n12\n\tbalance\tbegins\twhen\tvitamin\tB\n12\n\tintake\tis\tlow\tor
|
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12\n\tbalance\tbegins\twhen\tvitamin\tB\n12\n\tintake\tis\tlow\tor\nabsorption\tis\tpoor,\tdepleting\tthe\tprimary\tdelivery\tprotein,\tTCII.\tA\tlow\tTCII\t(<40\tpg/mL)\tmay\nbe\tthe\tearliest\tdetectable\tsign\tof\ta\tvitamin\tB\n12\n\tdeficiency\n\t(\nNexo\tand\tHoffmann-Lucke,\n2011\n).\tThis\tis\ta\tvitamin\tB\n12\n\tpredeficiency\tstage.\nStage\t2:\tVitamin\tB\n12\n\tdepletion\tshows\ta\tlow\tB\n12
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] |
Stage\t2:\tVitamin\tB\n12\n\tdepletion\tshows\ta\tlow\tB\n12\n\ton\tTCII\tand\ta\tgradual\tlowering\tof\tB\n12\n\tin\nhaptocorrin\t(holohap\t<50\tpg/mL),\tthe\tstorage\tprotein.\nStage\t3:\tDamaged\tmetabolism\tand\tvitamin\tB\n12\n–deficient\terythropoiesis\tincludes\tan\tabnormal\ndU\tsuppression,\thypersegmentation,\ta\tdecreased\tTIBC\tand\tholohap\tpercent\tsaturation,\ta
|
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] |
low\tRCF\tlevel\t(<140\tng/mL),\tand\tsubtle\tneuropsychiatric\tdamage\t(impaired\tshort-term\tand\nrecent\tmemory).\nStage\t4:\tClinical\tdamage\toccurs,\tincluding\tvitamin\tB\n12\n\tdeficiency\tanemia;\tit\tincludes\tall\npreceding\tparameters,\talong\twith\tmacroovalocytic\terythrocytes,\televated\tMCV,\televated
|
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] |
TCII\tlevels,\tincreased\thomocysteine\tand\tmethylmalonic\tacid\tlevels,\tand\tmyelin\tdamage.\nLeukoencephalopathy\tand\tautonomic\n\tdysfunction\toccur\twith\tvery\tlow\tserum\tB\n12\n\tlevels\n(<200\tpg/mL);\tpsychiatric\tchanges,\tneuropathy,\tand\tdementia\talso\tmay\toccur\t(\nGraber\tet\tal,\n2010\n)\t(see\t\nFig.\t31.3\n).\nClinical\tfindings
|
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] |
Graber\tet\tal,\n2010\n)\t(see\t\nFig.\t31.3\n).\nClinical\tfindings\nPernicious\tanemia\taffects\tnot\tonly\tthe\tblood\tbut\talso\tthe\tgastrointestinal\ttract\tand\tthe\tperipheral\nand\tcentral\tnervous\tsystems.\tThis\tdistinguishes\tit\tfrom\tfolate-deficiency\tanemia.\tThe\tovert\nsymptoms,\twhich\tare\n\tcaused\tby\tinadequate\tmyelinization\tof\tthe\tnerves,\tinclude\tparesthesia
|
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] |
(especially\tnumbness\tand\ttingling\tin\tthe\thands\tand\tfeet),\tdiminution\tof\tthe\tsenses\tof\tvibration\tand\nposition,\tpoor\tmuscular\tcoordination,\tpoor\tmemory,\tand\thallucinations.\tIf\tthe\tdeficiency\tis\nprolonged,\tthe\tnervous\tsystem\tdamage\tmay\tbe\tirreversible,\teven\twith\tinitiation\tof\tvitamin\tB\n12\ntreatment.\nHelicobacter\tpylori\n\tcauses\tpeptic
|
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] |
12\ntreatment.\nHelicobacter\tpylori\n\tcauses\tpeptic\n\tulcer\tdisease\tand\tchronic\tgastritis\t(see\t\nChapter\t26\n).\tBoth\nconditions\tare\tassociated\twith\thypochlorhydria,\treduced\tproduction\tof\tIF\tby\tepithelial\tcells\tin\tthe\nstomach,\tvitamin\tB\n12\n\tmalabsorption,\tand\tpernicious\tanemia.\tThere\tis\talso\ta\tcorrelation\tbetween
|
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0.06858646869659424,
0.10950852185487747,
0.07108398526906967,
0.006101085804402828
] |
autoimmune\tgastritis\tand\tpernicious\tanemia.\tMore\tthan\t90%\tof\tpatients\twith\tpernicious\tanemia\nhave\tparietal\tcell\tantibodies\t(PCAs),\tand\t50%\tto\n\t70%\thave\televated\tIF\tantibodies.\tSerum\tvitamin\tB\n12\nlevels\tof\tthe\t\nH.\tpylori\n–infected\tpatients\tare\tsignificantly\tlower\tthan\tthat\tof\tuninfected\tpatients.\nA\tstudy\ton\t\nH.\tpylori
|
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] |
A\tstudy\ton\t\nH.\tpylori\n\tinfection\tand\tautoimmune\ttype\tatrophic\tgastritis\texamined\tserum\tmarkers\tfor\ngastric\tatrophy\t(pepsinogen\tI,\tpepsinogen\tI/II,\tand\tgastrin)\tand\tautoimmunity.\tPositive\tserum\nautoimmune\tmarkers\t(IF\tantibodies\tand\tPCA)\tsuggest\tthat\n\t\nH.\tpylori\n\tcontributes\tto\tautoimmune\ngastritis\tand\tpernicious\tanemia\t(\nVeijola\tet\tal,\t2010\n).
|
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0.09689581394195557,
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0.02474670484662056,
0.008855506777763367,
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0.00018474184616934508,
0.0024127985816448927,
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0.017512094229459763,
0.12036550790071487,
-0.07726933807134628,
-0.05346624180674553,
0.03238138556480408,
0.016706272959709167,
-0.03782513737678528,
0.054356519132852554,
-0.03562088683247566,
-0.07418838143348694,
-0.06348611414432526,
0.06895755976438522,
-0.07671743631362915,
0.02885693684220314,
0.0036532660014927387,
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0.003208498703315854,
0.052633512765169144,
0.020443014800548553,
0.020323773846030235,
-0.05146446451544762,
-0.02540867030620575,
-0.07177027314901352,
-0.01648678444325924,
0.03828470781445503,
-0.01187930442392826,
-0.029999420046806335,
0.018078556284308434,
0.06607285887002945,
-0.019636530429124832,
0.0026873513124883175,
-0.046166740357875824,
0.04975627735257149,
0.07709314674139023,
-0.08557543158531189,
-0.04558871313929558,
0.057836633175611496,
-0.004970666486769915,
-0.08413559198379517,
0.011096852831542492,
0.0725884735584259,
0.0015977256698533893,
-0.016753870993852615,
-0.09239072352647781,
0.03570469096302986,
0.08523251861333847,
-0.0063901846297085285,
0.024470165371894836,
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0.08172795176506042,
0.04694881662726402,
0.0680982768535614,
-0.03537958487868309
] |
gastritis\tand\tpernicious\tanemia\t(\nVeijola\tet\tal,\t2010\n).\nVitamin\tB\n12\n\tdeficiency\tis\tan\timportant\tmodifiable\trisk\tfactor\tfor\tosteoporosis\tin\tmen\tand\twomen.\nAdults\twith\tlow\tvitamin\tB\n12\n\tlevels\thave\ta\tlower\taverage\tbone\tmineral\tdensity\tand\tgreater\trisk\tfor\nosteoporosis\t(\nKarpouzos\tet\tal,\t2017\n).\nReduced\tvitamin\tB\n12
|
[
0.012778600677847862,
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0.012813091278076172,
0.010618655011057854,
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0.07525958865880966,
0.0690392553806305,
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0.03549705445766449,
0.05026921629905701,
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0.02375914715230465,
0.07020390033721924,
0.07031354308128357,
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1.9083283858516106e-33,
0.016482746228575706,
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0.008317581377923489,
0.062337737530469894,
0.03913802281022072,
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0.035154398530721664,
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0.03753834590315819,
0.04357670247554779,
0.023872721940279007,
0.02679329365491867,
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0.0002207214420195669,
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0.008842973038554192,
0.13968466222286224,
0.0036818673834204674,
0.03593682497739792,
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0.021449167281389236,
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0.017215697094798088,
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0.01783204823732376,
0.011679946444928646,
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0.024139346554875374,
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0.030257660895586014,
0.02936360239982605,
0.029521668329834938,
0.0031403694301843643,
0.04505542293190956,
0.027002135291695595,
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0.093140609562397,
0.01821787841618061,
0.10100377351045609,
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0.06389278918504715,
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0.04444603994488716,
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0.07905607670545578,
0.030446650460362434,
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0.023597341030836105,
0.09825216233730316,
0.011317720636725426,
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0.04145127534866333,
0.012472698464989662,
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0.026979247108101845,
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0.04668692871928215,
0.0518445149064064,
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0.07189198583364487,
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0.03423968330025673,
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0.07174163311719894,
0.10659697651863098,
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0.055192213505506516,
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0.030693868175148964,
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0.013597207143902779,
0.03821004927158356,
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0.13577763736248016,
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0.02910575084388256,
0.037371765822172165,
0.019866153597831726,
0.09471343457698822,
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0.01356825977563858,
0.037035997956991196,
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0.05239502713084221,
0.07286186516284943,
0.05420820787549019,
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0.02488788403570652,
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0.05708630383014679,
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0.10959060490131378,
0.04214312881231308,
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0.07907574623823166,
0.0436614528298378,
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0.0556960292160511,
0.02717907726764679,
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0.05586455389857292,
0.10387729108333588,
0.0027058986015617847,
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0.008378908038139343,
0.05299752578139305,
0.06817565858364105,
0.07141738384962082,
0.050322651863098145
] |
osteoporosis\t(\nKarpouzos\tet\tal,\t2017\n).\nReduced\tvitamin\tB\n12\n\tstatus\tand\televated\thomocysteine\tconcentrations\tare\n\tcommon.\tThese\nalterations\tare\tproblematic\tamong\tvegans\t(\nElmadfa\tand\tSinger,\t2009\n).\tB\n12\n-folate-homocysteine\ninteractions\taggravate\theart\tdisease\tand\tmay\tlead\tto\tadverse\tpregnancy\toutcomes\t(\nGanguly\tand\nAlam,\t2015\n;
|
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0.025527289137244225,
0.007058884482830763,
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0.025229627266526222,
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0.06408590823411942,
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0.037376321852207184,
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0.006828972138464451,
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] |
Ganguly\tand\nAlam,\t2015\n;\t\nShahbazian\tet\tal,\t2016\n)\t(see\t\nChapters\t14\n\tand\t\n32\n).\nAssessment\nVitamin\tB\n12\n\tstores\tare\tdepleted\tafter\tseveral\tyears\twithout\tvitamin\tB\n12\n\tintake.\tA\tlow\tholo\tTCII\tvalue\n(<40\tpg/mL)\tis\ta\n\tsign\tof\tearly\tB\n12\n\tdeficiency.\nOther\tlaboratory\ttests\tthat\tmay\tbe\thelpful\tin\tdiagnosing\ta\tvitamin\tB\n12\n\tdeficiency\tand\tdetermining
|
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] |
12\n\tdeficiency\tand\tdetermining\nits\tcause\tinclude\tmeasurements\tof\tserum\tB\n12\n,\tIF\tantibody\t(IFAB),\tPCA,\tserum\thomocysteine\tand\nserum\tmethylmalonic\tacid\t(MMA)\tlevels\t(see\t\nChapter\t5\n\tand\t\nAppendix\t12\n).\tThe\tIFAB\tand\tPCA\ttests\ncan\tdetermine\twhether\tthe\tdeficiency\tis\tcaused\tby\ta\tlack\tof\tIF.\nMedical\tmanagement
|
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] |
Medical\tmanagement\nTreatment\tusually\tconsists\tof\tan\tintramuscular\tor\tsubcutaneous\tinjection\tof\t100\tmcg\tor\tmore\tof\nvitamin\tB\n12\n\tonce\tper\tweek.\tAfter\tan\tinitial\tresponse\tis\telicited,\tthe\tfrequency\tof\tadministration\tis\nreduced\tuntil\tremission\tcan\tbe\tmaintained\tindefinitely\twith\tmonthly\tinjections\tof\t100\tmcg.\tVery\nlarge\toral\tdoses\tof\tvitamin\tB\n12
|
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0.1390341967344284,
0.09049659222364426,
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] |
uremia,\tcoma,\tsevere\tdisorientation,\tor\tmarked\tneurologic\tdamage.\tA\tresponse\tto\ttreatment\tis\nevidenced\tby\timproved\tappetite,\talertness,\tand\tcooperation,\tfollowed\tby\timproved\thematologic\nresults,\tas\tmanifested\n\tby\tmarked\treticulocytosis\twithin\thours\tof\tan\tinjection.\nMedical\tnutrition\ttherapy
|
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] |
Medical\tnutrition\ttherapy\nA\thigh-protein\tdiet\t(1.5\tg/kg\tof\tbody\tweight)\tis\tdesirable\tfor\tblood\tcell\tregeneration.\tBecause\tgreen\nleafy\tvegetables\tcontain\tiron\tand\tfolate,\tthe\tdiet\tshould\tcontain\tincreased\tamounts\tof\tthese\tfoods.\nMeats\t(especially\tbeef\tand\tpork),\teggs,\tmilk,\tand\tmilk\tproducts\tare\tparticularly\trich\tin\tvitamin\tB\n12\n(see\t\nAppendix\t31
|
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] |
12\n(see\t\nAppendix\t31\n).\nFor\tthose\tindividuals\tprescribed\tmetformin\tfor\ttreatment\tof\tdiabetes,\t10%\tto\t30%\thave\treduced\nvitamin\tB\n12\n\tabsorption.\tMetformin\tnegatively\taffects\tthe\tcalcium-dependent\tmembrane\tand\tthe\tB\n12\n-\nIF\tcomplex\tby\tdecreasing\tthe\tabsorbability\tby\tthe\tileal\tcell\tsurface\treceptors.\tIncreased\tintake\tof
|
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] |
calcium\tmay\treverse\tthe\tvitamin\tB\n12\n\tmalabsorption.\tHowever\ta\trecent\tstudy\tfound\tthat\nsupplementation\twith\n\ta\tmultivitamin\tsupplement\twas\tprotective\tagainst\tB\n12\n\tdeficiency.\nThe\tInstitute\tof\tMedicine\trecommends\tthat\tpeople\tolder\tthan\tage\t50\tconsume\tvitamin\tB\n12\n\tin\tits
|
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12\n\tin\tits\ncrystalline\tform\t(i.e.,\tin\tfortified\tcereals\tor\tsupplements)\tto\tovercome\tthe\teffects\tof\tatrophic\ngastritis.\tThe\tRDAs\tfor\tB\n12\n\tare\tsummarized\tin\tthe\tfront\tof\tthe\tbook.\tThe\tRDA\tfor\tadult\tmen\tand\nwomen\tis\t2.4\tmcg\tdaily.\nOther\tnutritional\n\tanemias\nAnemia\tof\tprotein-energy\tmalnutrition
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] |
Other\tnutritional\n\tanemias\nAnemia\tof\tprotein-energy\tmalnutrition\nProtein\tis\tessential\tfor\tthe\tproper\tproduction\tof\themoglobin\tand\tRBCs.\tBecause\tof\tthe\treduction\tin\ncell\tmass\tand\tthus\toxygen\trequirements\tin\tprotein-energy\tmalnutrition\t(PEM),\tfewer\tRBCs\tare
|
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] |
required\tto\toxygenate\tthe\ttissue.\tBecause\tblood\tvolume\tremains\tthe\tsame,\tthis\treduced\tnumber\tof\nRBCs\twith\ta\tlow\themoglobin\tlevel\t(hypochromic,\tnormocytic\tanemia),\n\twhich\tcan\tmimic\tan\tiron\ndeficiency\tanemia,\tis\tactually\ta\tphysiologic\t(nonharmful)\trather\tthan\tharmful\tanemia.\tIn\tacute\tPEM,
|
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the\tloss\tof\tactive\ttissue\tmass\tmay\tbe\tgreater\tthan\tthe\treduction\tin\tthe\tnumber\tof\tRBCs,\tleading\tto\npolycythemia\n\t(an\tincrease\tin\tRBCs\twhere\tthey\tmake\tup\ta\tlarger\tproportion\tof\tthe\tblood\tvolume).\nThe\tbody\tresponds\tto\tthis\tRBC\tproduction,\twhich\tis\tnot\ta\treflection\tof\tprotein\n\tand\tamino\tacid
|
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and\tamino\tacid\ndeficiency\tbut\tof\tan\toversupply\tof\tRBCs.\tIron\treleased\tfrom\tnormal\tRBC\tdestruction\tis\tnot\treused\tin\nRBC\tproduction\tbut\tis\tstored\tso\tthat\tiron\tstores\tare\toften\tadequate.\tIron\tdeficiency\tanemia\tcan\nreappear\twith\trehabilitation\twhen\tRBC\tmass\texpands\trapidly.
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] |
12\n.\tThe\tnutrition\tcounselor\tplays\tan\nimportant\trole\tin\tassessing\trecent\tand\ttypical\tdietary\tintake\tof\tthese\tnutrients.\nCopper\tdeficiency\tanemia\nCopper\tand\tother\theavy\tmetals\tare\tessential\tfor\tthe\tproper\tformation\tof\themoglobin.\nCeruloplasmin\n,\ta\tcopper-containing\tprotein,\tis\n\trequired\tfor\tnormal\tmobilization\tof\tiron\tfrom\tits
|
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] |
required\tfor\tnormal\tmobilization\tof\tiron\tfrom\tits\nstorage\tsites\tto\tthe\tplasma.\tIn\ta\tcopper-deficient\tstate,\tiron\tcannot\tbe\treleased;\tthis\tleads\tto\tlow\nserum\tiron\tand\themoglobin\tlevels,\teven\tin\tthe\tpresence\tof\tnormal\tiron\tstores.\tOther\tconsequences\nof\tcopper\tdeficiency\tsuggest\tthat\tcopper\tproteins\tare\tneeded\tfor\tuse\tof\tiron\tby\tthe\tdeveloping
|
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infant\tformula.\tIt\talso\tmay\tbe\tseen\tin\tchildren\tor\tadults\twho\thave\ta\tmalabsorption\tsyndrome\tor\twho\nare\treceiving\tlong-term\ttotal\tparenteral\tnutrition\tthat\tdoes\tnot\n\tsupply\tcopper.\nSideroblastic\t(B\n6\n-responsive)\tanemia\nSideroblastic\t(pyridoxine-responsive)\tanemia\n\tis\tcharacterized\tby\ta\tderangement\tin\tthe\tfinal
|
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is\tcharacterized\tby\ta\tderangement\tin\tthe\tfinal\npathway\tof\theme\tsynthesis,\tleading\tto\ta\tbuildup\tof\timmature\tRBCs.\tIt\thas\tfour\tprimary\ncharacteristics:\t(1)\tmicrocytic\tand\thypochromic\tRBCs;\t(2)\thigh\tserum\tand\ttissue\tiron\tlevels\t(causing\nincreased\ttransferrin\tsaturation);\t(3)\tthe\tpresence\tof\tan\tinherited\n\tdefect\tin\tthe\tformation\tof\tδ-
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] |
mitochondria\tof\timmature\tRBCs.\tThese\tiron-laden\tmitochondria\tdo\tnot\tfunction\n\tnormally,\tand\tthe\ndevelopment\tand\tproduction\tof\tRBCs\tbecome\tineffective.\tThe\tsymptoms\tare\tthose\tof\tanemia\tand\niron\toverload.\tEven\tthough\tthe\tanemia\tresponds\tto\tthe\tadministration\tof\tpharmacologic\tdoses\tof
|
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] |
pyridoxine\tand\tthus\tis\treferred\tto\tas\tpyridoxine–responsive\tanemia,\tthe\tneurologic\tand\tcutaneous\nmanifestations\tof\tvitamin\tB\n6\n\tdeficiency\tare\tnot\tobserved.\tThis\tdistinguishes\tit\tfrom\tanemia\tcaused\nby\ta\tdietary\tvitamin\tB\n6\n\tdeficiency.\nTreatment\tconsists\tof\ta\ttherapeutic\ttrial\tdose\tof\t50\tto\t200\tmg\tdaily\tof\tpyridoxine\tor\tpyridoxal
|
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] |
phosphate\t(PLP\tor\tpyridoxal-5-phosphate)\twhich\tis\t30\tto\t150\ttimes\tthe\tRDA.\tIf\tthe\tanemia\tresponds\nto\tone\tor\tthe\tother,\tpyridoxine\ttherapy\tis\tcontinued\tfor\tlife.\tHowever,\tif\tthe\tanemia\tis\tonly\tpartially\ncorrected,\ta\tnormal\thematocrit\tvalue\tis\tnever\tregained.\tPatients\n\trespond\tto\tthis\ttreatment\tto\tvarying
|
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] |
respond\tto\tthis\ttreatment\tto\tvarying\ndegrees,\tand\tsome\tmay\tonly\tachieve\tnear-normal\themoglobin\tlevels.\nAcquired\tsideroblastic\tanemias\tsuch\tas\tthose\tattributable\tto\tdrug\ttherapy\t(isoniazid,\nchloramphenicol),\tcopper\tdeficiency,\thypothermia,\tand\talcoholism\tare\tnot\tresponsive\tto\tB\n6\nadministration.\nVitamin\tE–responsive\themolytic\tanemia
|
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] |
6\nadministration.\nVitamin\tE–responsive\themolytic\tanemia\nHemolytic\tanemia\n\toccurs\twhen\tdefects\tin\tRBC\tmembranes\tlead\n\tto\toxidative\tdamage\tand\neventually\tto\tcell\tlysis.\tThis\tanemia\tis\tcaused\tby\tshortened\tsurvival\tof\tmature\tRBCs.\tVitamin\tE,\tan\nantioxidant,\tis\tinvolved\tin\tprotecting\tthe\tmembrane\tagainst\toxidative\tdamage,\tand\tone\tof\tthe\tfew
|
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] |
signs\tnoted\tin\tvitamin\tE\tdeficiency\tis\tearly\themolysis\tof\tRBCs.\nNonnutritional\tanemias\nAnemia\tof\tpregnancy\nA\tphysiologic\tanemia\tis\tthe\tanemia\tof\tpregnancy,\twhich\tis\trelated\n\tto\tincreased\tblood\tvolume\tand\nusually\tresolves\twith\tthe\tend\tof\tthe\tpregnancy.\tHowever,\tdemands\tfor\tiron\tduring\tpregnancy\talso
|
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] |
are\tincreased\tso\tthat\tinadequate\tiron\tintake\tmay\talso\tplay\ta\trole\tin\twhether\tit\tdevelops\t(see\t\nChapter\n14\n\tfor\tfurther\tdiscussion).\nAnemia\tof\tchronic\tdisease\nAnemia\tof\tchronic\tdisease\toccurs\tfrom\tinflammation,\tinfection,\tautoimmune\tdisorders,\tchronic\nkidney\tand\tliver\n\tdisease\tand\tmalignancy\tbecause\tthere\tis\tdecreased\tRBC\tproduction,\tusually\tas\ta
|
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] |
result\tof\tdisordered\tiron\tmetabolism.\tFerritin\tlevels\tare\tnormal\tor\tincreased,\tbut\tserum\tiron\tlevels\nand\tTIBC\tare\tlow\t(see\t\nChapter\t5\n).\tIt\tis\timportant\tthat\tthis\tform\tof\tanemia,\twhich\tis\tmild\tand\nnormocytic,\tnot\tbe\tmistaken\tfor\tiron\tdeficiency\tanemia;\tiron\tsupplements\tshould\tnot\tbe\tgiven.\nStandard\ttherapy\tinvolves\ttreating
|
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] |
Standard\ttherapy\tinvolves\ttreating\n\tthe\tunderlying\tdisorder,\twhich\tusually\timproves\tor\tcorrects\tthis\nanemia\t(\nNemeth\tand\tGanz,\t2014\n).\tErythrocyte\ttransfusion\tand\terythropoiesis-stimulating\tagents\n(ESAs)\tmay\tbe\trequired\tin\trare\tbut\tsevere\tcases.\nSickle\tcell\tdisease\nPathophysiology\nSickle\tcell\tdisease\t(SCD)
|
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] |
Sickle\tcell\tdisease\nPathophysiology\nSickle\tcell\tdisease\t(SCD)\n\tdescribes\ta\tgroup\tof\tinherited\tblood\tdisorders\tof\tRBCs.\tIt\tis\ttypically\nassociated\twith\tAfrican\tancestry\tbut\taffects\tmillions\n\tof\tpeople\tworldwide\tincluding\tCentral\tand\nSouth\tAmerican,\tMediterranean,\tand\tSouth\tAsian\tpopulations\t(\nCenters\tfor\tDisease\tControl\tand
|
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] |
Prevention\t[CDC],\t2018\n).\tThose\taffected\tinherit\ttwo\tabnormal\themoglobin\tgenes\tcalled\themoglobin\nS,\tone\tfrom\teach\tparent.\tThis\tresults\tin\timpaired\themoglobin\tsynthesis,\twhich\tproduces\tsickle-\nshaped\tRBCs\tthat\tget\tcaught\tin\tcapillaries\tand\tdo\tnot\tcarry\toxygen\twell\t(\nFig.\t31.6\n).\tThe\tsickle-
|
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] |
Fig.\t31.6\n).\tThe\tsickle-\nshaped\tRBCs\tdie\tearlier\tthan\ttypical\tRBCs,\tusually\tin\t10\tto\t20\tdays.\tThe\tbone\tmarrow\tcannot\tmake\nnew\tcells\tfast\tenough\tto\treplace\tthem,\twhich\tcan\tresult\tin\tanemia\tand\tenlargement\tof\tthe\tspleen.\nThe\tdisease\tis\tusually\tdiagnosed\tat\tbirth\tand\taffects\t100,000\tin\tthe\tUnited\tStates,\talthough\t1\tto\t3
|
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] |
million\tAmericans\thave\tthe\tsickle\tcell\ttrait,\tcharacterized\tby\thaving\tonly\tone\tcopy\n\tof\tthe\tsickle\tcell\ngene.\t(\nCenters\tfor\tDisease\tControl\tand\tPrevention\t[CDC],\t2018\n).\nFIG.\t31.6\nA,\n\tNormal\tred\tblood\tcells\tand\t\nB,\n\tAbnormal,\tsickled\tred\tblood\tcells.\n\tSource:\t(From\tNational\tInstitutes\tof
|
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] |
Source:\t(From\tNational\tInstitutes\tof\nHealth\t(NIH),\tNational\tHeart,\tLung,\tand\tBlood\tInstitute\t(NHLBI):\t\nSickle\tcell\tdisease\n\t(website).\t\t\nhttps://www.nhlbi.nih.gov/health-\ntopics/sickle-cell-disease\n,\t2018.)\nIn\taddition\tto\tanemia,\tSCD\tis\tcharacterized\tby\tepisodes\tof\tpain\tresulting\tfrom\tthe\tocclusion\tof\nsmall\tblood\tvessels
|
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] |
small\tblood\tvessels\n\tby\tthe\tabnormally\tshaped\terythrocytes.\tThe\tocclusions\tfrequently\toccur\tin\tthe\nabdomen,\tcausing\tacute,\tsevere\tabdominal\tpain.\tThe\themolytic\tanemia\tand\tvasoocclusive\tdisease\ncan\tresult\tin\timpaired\tliver\tfunction,\tjaundice,\tgallstones,\tand\tdeteriorating\trenal\tfunction.\tThe
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] |
constant\themolysis\tof\terythrocytes\tincreases\tiron\tstores\tin\tthe\tliver;\thowever,\tiron\tdeficiency\tanemia\nand\tSCD\tcan\tcoexist.\n\tIron\toverload\tis\tless\tcommon\tand\tis\tusually\ta\tproblem\tonly\tin\tthose\twho\thave\nreceived\tmultiple\tblood\ttransfusions.\nTypically\tserum\thomocysteine\tlevels\tare\televated,\twhich\tmay\tbe\tdue\tto\tlow\tconcentrations\tof\nvitamin\tB\n6
|
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0.10347616672515869,
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0.08856197446584702,
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] |
vitamin\tB\n6\n.\tChildren\twith\tSCD\twere\tfound\tto\thave\tthese\tlower\tvitamin\tB\n6\n\tlevels\tdespite\tB\n6\n\tintakes\ncomparable\tto\tthose\tof\tunaffected\tchildren.\nMedical\tmanagement\nA\tnew\tset\tof\tguidelines\n\tfor\tmanaging\tSCD\trecommends\tusing\tmonthly\tblood\ttransfusions\tand\tthe\ndrug\thydroxyurea\t(\nYawn\tet\tal,\t2014
|
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] |
drug\thydroxyurea\t(\nYawn\tet\tal,\t2014\n).\tConsistent\tblood\ttransfusions\tstop\tthe\tbody\tfrom\tproducing\nsickle\tcells\tand\tattempts\tto\tnormalize\tRBC\tcount.\tHydroxyurea\tincreases\tthe\tproduction\tof\thealthy\nfetal\themoglobin,\treducing\thospitalizations.\tBecause\thydroxyurea\talso\tlowers\tthe\tnumber\tof\twhite\nblood\tcells,\tpatients\tmust\tbe\tmonitored
|
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] |
blood\tcells,\tpatients\tmust\tbe\tmonitored\n\tregularly\twith\tblood\ttests.\nOther\ttreatment\tfor\tSCD\tfocuses\ton\trelieving\tpain\tduring\ta\tcrisis,\tkeeping\tthe\tbody\toxygenated\n(using\toxygen\ttherapy\tif\tneeded),\tand\tpossibly\tadministering\tan\texchange\ttransfusion.\tIt\tis\nimportant\tthat\tSCD\tnot\tbe\tmistaken\tfor\tiron\tdeficiency\tanemia,\twhich\tcan\tbe\ttreated\twith\tiron
|
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] |
supplements,\tbecause\tiron\tstores\tin\tthe\tpatient\twith\tSCD\tsecondary\tto\ttransfusions\tare\n\tfrequently\nexcessive.\nZinc\tcan\tincrease\tthe\toxygen\taffinity\tof\tnormal\tand\tsickle-shaped\terythrocytes.\tThus\tzinc\nsupplements\tmay\tbe\tbeneficial\tin\tmanaging\tSCD,\tespecially\tbecause\tdecreased\tplasma\tzinc\tis
|
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common\tin\tchildren\twith\tthe\tSS\tgenotype\tSCD\tand\tis\tassociated\twith\tdecreased\tlinear\tand\tskeletal\ngrowth,\tmuscle\tmass,\tand\tsexual\tmaturation.\tZinc\tsupplementation\talso\tmay\tprevent\tthe\tdeficit\tin\ngrowth\tthat\tappears\tin\tthese\tchildren\t(\nHyacinth\tet\tal,\t2010\n)\tBecause\tzinc\tcompetes\twith\tcopper\tfor
|
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binding\tsites\ton\tproteins,\tthe\tuse\tof\thigh\tdoses\tof\tzinc\tmay\tcause\tcopper\tdeficiency,\tso\nsupplementation\twith\tat\tleast\tthe\tRDA\tof\tcopper\tis\trecommended.\nMedical\tnutrition\ttherapy\nChildren\twith\tSCD\tand\ttheir\tfamilies\tshould\treceive\tinstruction\tabout\thow\tthey\tcan\tdevelop\ta\twell-\nbalanced\tfood\tplan
|
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] |
probably\tis\tdue\tto\ta\tconstant\tinflammation\tand\toxidative\tstress\t(\nHyacinth\tet\tal,\t2010\n;\t\nYawn\tet\tal,\n2014\n).\tTherefore\ttheir\tdiets\n\tmust\tbe\thigh\tenough\tin\tcalories\tto\tmeet\tthese\tneeds\tand\tmust\tprovide\nfoods\thigh\tin\tfolate\tand\tthe\ttrace\tminerals\tzinc\tand\tcopper\t(see\t\nAppendix\t47\n\tfor\tsources\tof\tzinc).
|
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] |
Appendix\t47\n\tfor\tsources\tof\tzinc).\nIn\taddition,\tthese\tchildren\tmay\tbe\tlow\tin\tvitamins\tA,\tC,\tD,\tand\tE;\tfolate;\tcalcium;\tand\tfiber.\tThe\ndiet\tshould\tbe\thigh\tin\tfolate\t(400\tto\t600\tmcg\tdaily)\tbecause\tthe\tincreased\tproduction\tof\terythrocytes\nneeded\tto\treplace\tthe\tcells\n\tbeing\tcontinuously\tdestroyed\talso\tincreases\tfolate\trequirements\t(see\nAppendix\t31\n).
|
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] |
Appendix\t31\n).\nWhen\tassessing\tthe\tnutrition\tstatus\tof\tpatients\twith\tSCD,\tclinicians\tmust\tpay\tattention\tto\tthe\nquestions\trelated\tto\tthe\tuse\tof\tvitamin\tand\tmineral\tsupplements,\tthe\tconsumption\tof\talcohol\t(which\nincreases\tiron\tabsorption),\tand\tsources\tof\tprotein\t(animal\tsources\tbeing\thigh\tin\tzinc\tand\tiron)\tin\tthe\ndiet.\tA\tmultivitamin
|
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] |
diet.\tA\tmultivitamin\n\tand\tmineral\tsupplement\tcontaining\t50%\tto\t150%\tof\tthe\tRDA\tfor\tfolate,\tzinc,\tand\ncopper\t(not\tiron)\tis\trecommended.\nDietary\tfluid\tand\tsodium\tintake\tinfluence\tthe\trisk\tfor\tvasoocclusive\tevents\tin\tSCD;\tincreasing\tfluid\nintake\tand\tlimiting\thigh-sodium\tfoods\tshould\tbe\tdiscussed\t(\nFowler\tet\tal,\t2010\n)\t(see\t\nChapter\t32\n).
|
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] |
Fowler\tet\tal,\t2010\n)\t(see\t\nChapter\t32\n).\nIntake\tof\t2\tto\t3\tquarts\tof\twater\tdaily\tis\trecommended.\tFinally,\tit\tis\timportant\tto\tremember\n\tthat\npatients\twith\tSCD\tmay\trequire\thigher\tthan\tRDA\tamounts\tof\tprotein.\nIf\tit\tis\tnecessary\tfor\tthe\tdiet\tto\tbe\tlow\tin\tabsorbable\tiron,\tthe\tdiet\tshould\temphasize\tvegetable
|
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] |
proteins.\tIron-rich\tfoods,\tsuch\tas\tliver,\tiron-fortified\tformula,\tiron-fortified\tcereals,\tand\tiron-fortified\nenergy\tbars\tand\tiron-fortified\tsport\tdrinks,\tshould\tbe\texcluded.\tSubstances\tsuch\tas\talcohol\tand\nvitamin\tC\tsupplements,\n\tboth\tof\twhich\tenhance\tiron\tabsorption,\tshould\tbe\tavoided.\tRarely,\tiron
|
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] |
deficiency\tmay\tbe\tpresent\tin\tsome\tpatients\twith\tSCD;\tiron\tdeficiency\tshould\tbe\tconfirmed\tand\tthe\ndiet\tadjusted\tappropriately.\nHypochromic\tmicrocytic\ttransient\tanemia\t(sports\tanemia)\nIncreased\tRBC\tdestruction,\talong\twith\tdecreased\themoglobin,\tserum\tiron,\tand\tferritin\nconcentrations,\tmay\toccur\tat\tthe\tinitiation\tand\tearly
|
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] |
concentrations,\tmay\toccur\tat\tthe\tinitiation\tand\tearly\n\tstages\tof\ta\tvigorous\ttraining\tprogram.\t\nSports\nanemia\n\tis\tassociated\twith\ta\treduction\tin\themoglobin\tin\tthe\tearly\tstages\tof\taerobic\ttraining\tdue\tto\nhemodilution.\tThe\tadaptations\tare\tconsidered\tadvantageous\tand\tdo\tnot\timpair\tphysical\tperformance\n(see\t\nChapter\t22\n\tfor\tfurther\tdiscussion).
|
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] |
(see\t\nChapter\t22\n\tfor\tfurther\tdiscussion).\nAthletes\twho\thave\themoglobin\tconcentrations\tbelow\tthose\tneeded\tfor\toptimal\toxygen\tdelivery\tmay\nbenefit\tfrom\tconsuming\n\tnutrient\tand\tiron-rich\tfoods;\tensuring\tthat\ttheir\tdiets\tcontain\tadequate\nprotein;\tand\tavoiding\ttea,\tcoffee,\tantacids,\tH\n2\n-blockers,\tand\ttetracycline,\tall\tof\twhich\tinhibit\tiron
|
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] |
2\n-blockers,\tand\ttetracycline,\tall\tof\twhich\tinhibit\tiron\nabsorption.\tNo\tathlete\tshould\ttake\tiron\tsupplements\tunless\ttrue\tiron\tdeficiency\tis\tdiagnosed\tbased\non\ta\tcomplete\tblood\tcell\tcount\twith\tdifferential,\tserum\tferritin\tlevel,\tserum\tiron\tlevel,\tTIBC,\tand\npercent\tsaturation\tof
|
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] |
percent\tsaturation\tof\n\tiron-binding\tcapacity.\tAthletes\twho\tare\tfemale,\tvegetarian,\tinvolved\tin\nendurance\tsports,\tor\tentering\ta\tgrowth\tspurt\tare\tat\trisk\tfor\tiron\tdeficiency\tanemia\tand\ttherefore\nshould\tundergo\tperiodic\tmonitoring\t(see\t\nChapter\t22\n).\nThalassemias\nThalassemias
|
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0.002533451421186328
] |
Chapter\t22\n).\nThalassemias\nThalassemias\n\t(alpha\tand\tbeta)\tare\tinherited\tanemias\tcharacterized\tby\tmicrocytic,\thypochromic,\nand\tshort-lived\tRBCs\tresulting\tfrom\tdefective\themoglobin\tsynthesis,\n\twhich\tprimarily\taffect\tpersons\nfrom\tthe\tMediterranean,\tSouthern\tAsia,\tAfrica,\tand\tthe\tMiddle\tEast\t(\nNational\tHeart,\tLung,\tand\nBlood\tInstitute,\t2014
|
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0.03618961572647095,
-0.04737158119678497
] |
National\tHeart,\tLung,\tand\nBlood\tInstitute,\t2014\n).\tSeverity\tof\tthe\tdisorder\tranges\tfrom\tasymptomatic\tor\tmild\tanemia\tto\tmore\nsevere\tsymptoms\trequiring\troutine\tblood\ttransfusions.\tThe\tineffective\terythropoiesis\tleads\tto\tan\nincrease\tin\tplasma\tvolume,\tprogressive\tsplenomegaly,\tand\tbone\tmarrow\texpansion\n\twith\tthe\tresult\tof
|
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] |
with\tthe\tresult\tof\nfacial\tdeformities,\tosteomalacia,\tand\tbone\tchanges.\tUltimately\tthere\tis\tincreased\tiron\tabsorption\nand\tprogressive\tiron\tdeposition\tin\ttissues,\tresulting\tin\toxidative\tdamage.\tThe\taccumulation\tof\tiron\ncauses\tdysfunction\tof\tthe\theart,\tliver,\tand\tendocrine\tglands.\tBecause\tpatients\twith\tthe\tmore\tsevere
|
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] |
form\trequire\ttransfusions\tto\tstay\talive,\tthey\talso\tmust\thave\tregular\tchelation\ttherapy\n\tto\tprevent\tthe\ndamaging\tbuildup\tof\tiron\tthat\tcan\toccur.\tImpaired\tgrowth\tin\tchildren\taccompanying\tthalassemia\nmajor\tcan\tbe\tpartially\tcorrected\tby\tincreasing\tcaloric\tintake.\nMedical\tnutrition\ttherapy
|
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] |
Medical\tnutrition\ttherapy\nThe\tdiet\tshould\temphasize\tfoods\thigh\tin\tfolate,\tvitamins\tA\tand\tC,\tand\ttrace\tminerals,\tincluding\tzinc,\ncopper,\tand\tselenium\t(\nCunningham,\t2016\n).\tAdditionally,\tadequate\tintake\tof\tcalcium\tand\tvitamin\n\tD\tis\nneeded\tto\tsupport\tbone\thealth.\tPatients\tnot\treceiving\tblood\ttransfusions\tshould\tconsume\ta
|
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moderately\tlow-iron\tdiet\tthat\tlimits\tiron-fortified\tfoods\tand\thigh\tred\tmeat\tintakes.\tMultivitamin\tand\nmineral\tsupplements\tthat\tcontain\tamounts\tof\tiron\tand\tvitamin\tC\tabove\tthe\tRDA\tshould\tbe\talso\navoided.\tPatients\treceiving\ttransfusions\twith\tchelation\ttherapy\tdo\tnot\tneed\tto\tfollow\ta\tlow-iron\tdiet.\nCLINICAL\tCASE\tSTUDY
|
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] |
CLINICAL\tCASE\tSTUDY\nMarisa,\ta\t27-year-old\tHispanic\tfemale,\treports\tincreased\tsymptoms\tof\trestless\tlegs\tsyndrome,\nfatigue,\tand\theavy\tmenses\tfor\tthe\tpast\tyear.\tA\tphysical\texamination\treveals\tinflammation\tand\ntenderness\taround\ther\tknee\tand\tankle\tjoints.\nHer\ttypical\tdaily\tintake\tincludes:
|
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] |
32\nMedical\tnutrition\ttherapy\tfor\ncardiovascular\tdisease\nJanice\tL.\tRaymond,\tMS,\tRDN,\tCSG,\tSarah\tC.\tCouch,\tPhD,\tRDN\nKEY\tTERMS\n3-hydroxy-3-methylglutaryl–\tcoenzyme\tA\t(HMG-CoA)\nangina\nangiography\napolipoproteins\natherosclerotic\tcardiovascular\tdisease\t(ASCVD)\natheroma\nbile\tacid\tsequestrant\nblood\tpressure\nB-natriuretic\tpeptide\t(BNP)\ncardiac\tcachexia
|
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blood\tpressure\nB-natriuretic\tpeptide\t(BNP)\ncardiac\tcachexia\ncardiac\tcatheterization\ncardiovascular\tdisease\t(CVD)\nC-reactive\tprotein\t(hs-CRP)\nCerebrovascular\tAccident\t(CVA)\nchylomicron\ncoronary\tartery\tbypass\tgraft\t(CABG)\ndiastolic\tblood\tpressure\t(DBP)\nDietary\tApproaches\tto\tStop\tHypertension\t(DASH)\ndyslipidemia\ndyspnea\nedema\nendothelial\tcell
|
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0.07680099457502365,
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] |
dyslipidemia\ndyspnea\nedema\nendothelial\tcell\nessential\thypertension\nfamilial\tcombined\thyperlipidemia\t(FCHL)\nfamilial\tdysbetalipoproteinemia\nfamilial\thypercholesterolemia\n\t(FH)\nfatty\tstreak\nfoam\tcells\nheart\tfailure\t(HF)\nhigh-density\tlipoprotein\t(HDL)\nhomocysteine\nhypertension\nhypertriglyceridemia\nintermediate-density\tlipoprotein\t(IDL)\nischemia
|
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] |
hypertriglyceridemia\nintermediate-density\tlipoprotein\t(IDL)\nischemia\nleft\tventricular\thypertrophy\t(LVH)\nlipoprotein\nlow-density\tlipoprotein\t(LDL)\nMediterranean\tdiet\t(MeD)
|
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] |
metabolic\tsyndrome\nmyocardial\tinfarction\t(MI)\nnitric\toxide\t(NO)\nplaque\nprehypertension\nrenin-angiotensin\n\tsystem\t(RAS)\nsecondary\thypertension\nstatins\nstroke\nsyncope\nsystolic\tblood\tpressure\t(SBP)\nthrombus\ntrans\tfatty\tacids\ntransient\tischemic\tattack\t(TIA)\ntrimethylamine-N-oxide\t(TMAO)\nvery-low-density\tlipoprotein\t(VLDL)\nxanthoma
|
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] |
very-low-density\tlipoprotein\t(VLDL)\nxanthoma\nCardiovascular\tdisease\t(CVD)\n\tis\ta\tgroup\tof\tinterrelated\tdiseases\tthat\tincludes\tatherosclerosis,\nhypertension,\tischemic\theart\tdisease,\tperipheral\tvascular\tdisease,\n\tand\theart\tfailure\t(HF).\tThese\ndiseases\tare\tinterrelated\tand\toften\tcoexist.\tAn\testimated\t84,000,000\tadult\tAmericans\t(one\tin\tthree)
|
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have\tone\tor\tmore\ttypes\tof\tCVD\t(\nBox\t32.1\n).\nBOX\t32.1\nTypes\tand\tIncidence\tof\tCardiovascular\tDisease\tin\tthe\tUnited\nStates\nHypertension:\t75,000,000\nCoronary\theart\tdisease:\t25,155,000\nMyocardial\tinfarction:\t790,000\nHeart\tfailure:\t6,500,000\nStroke:\t7,950,000
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] |
Heart\tfailure:\t6,500,000\nStroke:\t7,950,000\nBecause\tof\tcomorbidities,\tit\tis\tnot\tpossible\tto\tadd\tthese\tnumbers\ttogether\tto\treach\ta\ttotal\t(American\nHeart\tAssociation\t[AHA],\t2010;\t\nhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408160/\n;\nhttps://www.cdc.gov/heartdisease/heart_attack.htm\n).
|
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] |
;\nhttps://www.cdc.gov/heartdisease/heart_attack.htm\n).\nCVD\tremains\tthe\tnumber\tone\tkiller\tof\tmen\tand\twomen\tin\tthe\tUnited\tStates;\tone\tof\tevery\tthree\ndeaths\tis\tattributed\tto\tCVD.\tCVD\tis\tthe\tcause\tof\tmore\tdeaths\n\tthan\tcancer,\tchronic\tlower\trespiratory\ndiseases,\tand\taccidents\tcombined.\tEvery\t25\tseconds,\tan\tAmerican\tsuffers\ta\tcoronary\tevent\tand
|
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] |
about\tevery\tminute\tsomeone\twill\tdie\tof\tone.\tOn\taverage,\tsomeone\tin\tthe\tUnited\tStates\tsuffers\ta\nstroke\tevery\t40\tseconds\t(\nAmerican\tHeart\tAssociation\t[AHA],\t2015\n).\tThe\tlifetime\trisk\tfor\tCVD\tin\nAmerican\tmen\tis\ttwo\tin\tthree\tand\tfor\twomen\tis\tone\tin\ttwo\t(\nAHA,\t2015\n).\tWorldwide,\n\t18\tmillion\ndeaths\tper\tyear\tare\tattributed\tto\tCVD\t(\nYusuf\tet\tal,\t2014\n).
|
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0.0708426684141159,
0.04182726889848709,
0.05268091335892677,
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] |
deaths\tper\tyear\tare\tattributed\tto\tCVD\t(\nYusuf\tet\tal,\t2014\n).\nAtherosclerotic\tcardiovascular\tdisease\t(ASCVD)\n\tinvolves\tthe\tnarrowing\tof\tsmall\tblood\tvessels\nthat\toxygenate\tthe\theart\tmuscle\tby\tthe\tbuild-up\tof\t\nplaque\n\t(the\tlesion\tin\tthe\tblood\tvessels).\tThe
|
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] |
plaque\n\t(the\tlesion\tin\tthe\tblood\tvessels).\tThe\nplaque,\tknown\tas\tatherosclerosis,\tcan\trupture,\tcausing\ta\tblood\tclot\tto\tform\tthat\tblocks\tthe\tartery\tor\ntravels\tsomewhere\telse\tin\tthe\tbody,\n\tcausing\tblockage\tat\tthat\tsite.\tThe\tresult\tcan\tbe\ta\t\nmyocardial\ninfarction\t(MI)\n,\twhich\tis\talso\tcalled\ta\theart\tattack\tor\tin\tthe\tbrain\tit\tis\tcalled\tan\tischemic
|
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] |
stroke\n,\nwhich\tis\talso\tknown\tas\ta\t\ncerebrovascular\taccident\t(CVA)\n.\tHeart\tdisease\tand\tstroke\tcause\tthe\nmost\tdeaths\tin\tboth\tsexes\tof\tall\tethnic\tgroups,\tincreasing\twith\tage.\tUntil\tthe\tage\tof\t65\tyears,\tblack\nmen\thave\tthe\thighest\trates\tof\tASCVD\tdeaths;\n\tthereafter,\twhite\tmen\thave\tthe\thighest\trates.\tBlack
|
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] |
thereafter,\twhite\tmen\thave\tthe\thighest\trates.\tBlack\nwomen\thave\thigher\trates\tthan\twhite\twomen\tat\tall\tages.\tAmong\twhites\tolder\tthan\tage\t18,\t12.1%\nhave\tCVD.\tIn\tthe\tsame\tage\tgroup,\t10.2%\tof\tblacks\thave\theart\tdisease,\tand\tin\tHispanics\tthe\nincidence\tis\t8.1%.\tThe\tincidence\tin\tadult\tNative\tAmericans\tis\t12.1%,\tin\tNative\tHawaiians\tor\tother
|
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] |
Pacific\tIslanders\tit\tis\t19.7\t%,\tand\tin\tAsians\tit\tis\t5.2%\t(\nAHA,\t2015\n).\tThis\tchapter\tdiscusses\tthe\nincidence,\tpathophysiologic\tfindings,\tprevention,\tand\ttreatment\tof\teach\tof\tthe\tCVDs.\nAtherosclerosis\tand\tcoronary\theart\tdisease\nAnatomy\tand\tphysiology\nBlood\tvessels\tare\tcomposed\tof\tthree\tlayers.\tThe\touter\tlayer\tis\tmainly\tconnective\ttissue\tthat\tgives
|
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structure\tto\tthe\tvessels.\tThe\tmiddle\tlayer\tis\tsmooth\tmuscle\tthat\tcontracts\tand\tdilates\tto\tcontrol
|
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blood\tflow\tand\n\tblood\tpressure.\tThe\tinner\tlining\tis\ta\tthin\tlayer\tof\t\nendothelial\tcells\n\t(the\nendothelium)\tthat\tin\ta\thealthy\tstate\tis\tsmooth\tand\tresponsive.\tThe\tendothelium\tfunctions\tas\ta\nprotective\tbarrier\tbetween\ttissues\tand\tcirculating\tblood.\tIt\tfacilitates\tbidirectional\tpassage\tof
|
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.\tNO\tis\ta\tsoluble\tgas\tcontinually\tsynthesized\tfrom\tthe\namino\tacid\tl-arginine\tin\tendothelial\tcells.\tNO\thas\ta\twide\trange\tof\tbiologic\tproperties\tthat\tmaintain\nvascular\thomeostasis.\tIt\tappears\tto\tbe\tinvolved\tin\tprotection\tfrom\tinjurious\tsubstances\tand\tplays\ta\nkey\trole\tin\tvasodilation\t(\nTousoulis\tet\tal,\t2012
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key\trole\tin\tvasodilation\t(\nTousoulis\tet\tal,\t2012\n).\tDecreased\tNO\tis\ta\tfactor\tin\tthe\tendothelial\tcell\ndysfunction\tthat\tdisrupts\tvascular\tbalance\tand\tcan\tresult\tin\tvasoconstriction,\tplatelet\tactivation,\nleukocyte\tadherence,\tand\tvascular\tinflammation.\nPathophysiology
|
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] |
leukocyte\tadherence,\tand\tvascular\tinflammation.\nPathophysiology\nASCVD\tinvolves\tthe\taccumulation\tof\tplaque\twithin\tthe\twalls\tof\tthe\tarteries.\tIt\tstarts\twith\tinjury\tto\nthe\tendothelial\tcells\twith\tan\tassociated\tinflammatory\tresponse\tinvolving\tphagocytes\n\tand\tmonocytes.\nOnce\tin\tthe\ttissue,\tmonocytes\tevolve\tinto\ta\tspecialized\ttype\tof\tmacrophage\tcalled\ta
|
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] |
foam\tcell\n\tthat\ningests\toxidized\tcholesterol\tand\tbecomes\t\nfatty\tstreaks\n\tin\tthese\tvessels.\tIntracellular\nmicrocalcification\toccurs,\tforming\tdeposits\twithin\tthe\tvascular\tsmooth\tmuscle\tcells\tof\tthe\nsurrounding\tmuscular\tlayer\t(\nFig.\t32.1\n).\nFIG.\t32.1\nThe\tstructure\tof\tmature,\tstable,\tand\tunstable\tplaque.\n\tSource:\t(From\tRudd\tJHF\tet\tal:\tImaging\tof
|
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Source:\t(From\tRudd\tJHF\tet\tal:\tImaging\tof\natherosclerosis—can\twe\tpredict\tplaque\trupture?\t\nTrends\tCardiovasc\tMed\n\t15:17,\t2005.)\nA\tprotective\tfibrin\tlayer\tor\t\natheroma\n\tforms\tbetween\tthe\tfatty\tdeposits\tand\tthe\tartery\tlining.\nAtheromas\tproduce\tenzymes\tthat\tcause\tthe\tartery\tto\tenlarge\tover\ttime,\tthus\tcompensating\tfor\tthe\nnarrowing\tcaused
|
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] |
narrowing\tcaused\n\tby\tthe\tplaque.\tThis\t“remodeling”\tof\tthe\tshape\tand\tsize\tof\tthe\tblood\tvessel\tmay\nresult\tin\tan\taneurysm.\tAtheromas\tcan\trupture\tor\tbreak\toff,\tforming\ta\t\nthrombus\n\t(blood\tclot),\twhere\nthey\tattract\tblood\tplatelets\tand\tactivate\tthe\tclotting\tsystem\tin\tthe\tbody.\tThis\tresponse\tcan\tresult\tin\ta\nblockage\tand\trestricted\tblood\tflow.
|
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] |
blockage\tand\trestricted\tblood\tflow.\nOnly\thigh-risk\tor\tvulnerable\tplaque\tforms\tthrombi.\tVulnerable\tplaques\tare\tlesions\n\twith\ta\tthin\nfibrous\tcap,\tfew\tsmooth\tmuscle\tcells,\tmany\tmacrophages\t(inflammatory\tcells),\tand\ta\tlarge\tlipid\tcore\n(\nFig.\t32.2\n).\tArterial\tchanges\tbegin\tin\tinfancy\tand\tprogress\tasymptomatically\tthroughout\tadulthood\n(\nFig.\t32.3\n).
|
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] |
FIG.\t32.2\nNatural\tprogression\tof\tatherosclerosis.\n\tSource:\t(From\tHarkreader\tH:\t\nFundamentals\tof\tnursing:\tcaring\tand\nclinical\tjudgment,\n\tPhiladelphia,\t2007,\tSaunders.)\nFIG.\t32.3\nPlaque\tthat\tcan\tbe\tsurgically\tremoved\tfrom\tthe\tcoronary\tartery.\n\tSource:\t(Photographs\tcourtesy\tRonald\tD.\nGregory\tand\tJohn\tRiley,\tMD.)
|
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] |
Source:\t(Photographs\tcourtesy\tRonald\tD.\nGregory\tand\tJohn\tRiley,\tMD.)\nThe\tclinical\toutcome\tof\timpaired\tarterial\tfunction\tarising\tfrom\tatherosclerosis\tdepends\ton\tthe\nlocation\tof\tthe\timpairment.\tIn\tthe\tcoronary\tarteries\tatherosclerosis\tcan\tcause\t\nangina\n\t(chest\tpain),\nMI,\tand\tsudden\tdeath;\tin\tthe\tcerebral\tarteries\tit\tcauses\n\tstrokes\tand
|
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] |
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