Nutritional deficiencies and blunted erythropoietin response as causes of the Amemia of critical illness*††
Journal of Critical Care, Volume 16, Issue 1, Pages 36-41
Purpose The purpose of this article was to determine the prevalence of iron, vitamin B12, and folate deficiency and to evaluate the erythropoietin (EPO) response to anemia in a cohort of long-term intensive care unit (ICU) patients.
Materials and Methods: All patients admitted to three academic medical center multidisciplinary ICUs were screened for eligibility into a randomized trial of EPO for the treatment of ICU anemia. On their second or third ICU day, patients enrolled in this trial had EPO levels drawn and were screened for iron, B12, and folate deficiency. Weekly EPO levels were obtained throughout patients' ICU stay.
Results: A total of 184 patients were screened for iron, B12, and folate deficiency. Sixteen patients (9%) were iron deficient by study criteria, 4 (2%) were B12 deficient, and 4 (2%) were folate deficient. Mean hemoglobin and reticulocyte percents of the remaining 160 patients were 10.3±1.2 g/dL and 1.66±1.09%, respectively. In most patients, serum iron and total iron binding capacity levels were very low, whereas ferritin levels were very high. Mean and median day 2 EPO levels were 35.2±35.6 mIU/mL and 22.7 mIU/mL, respectively (normal=4.2–27.. Serial EPO levels in most persistently anemic patients remained within the normal range.
Conclusions In this cohort, screening for iron, B12, and folate deficiency identified potentially correctable abnormalities in more than 13% of patients and should be considered in those who are anticipated to have long ICU stays. Even at an early point of critical illness, most patients had iron studies consistent with anemia of chronic disease (ACD), as well as a blunted EPO response that may contribute to this ACD-like anemia of critical illness.
The objective of our study was to investigate zinc (Zn) status and the effects of Zn supplementation in relation to iron deficiency anemia in middle-aged women. It is important to define the role of Zn in hematologic abnormalities and to determine the frequency of Zn deficiency.
Methods: Fifty-two Japanese women, selected from a health examination survey on 6200 women, had hemoglobin concentrations below 12.0 g/dl, total iron binding capacity (TIBC) below 390 µg/dl and fairly normocytemia. These 52 were divided into three groups and we then compared the hematological status before and after iron (group A) or Zn (group B) or iron plus Zn (group C) supplementation.
Results: After treatment, concentrations of hemoglobin (Hb) increased slightly in groups A and B, but not statistically significant. In group C, Hb levels were significantly increased from 10.8±1.1 to 12.8±1.1 g/dl. Furthermore, numbers of RBC and reticulocytes, and concentrations of albumin were also increased significantly. Increased values over 1.0 g/dl of hemoglobin levels were noted in four women (26.6%) in group A, three women (14.2%) in group B and 13 women (81.2%) in group C.
Conclusion: Zn status to some extent can account for hematological abnormalities in middle-aged women. At least 5.0% of middle-aged Japanese women may have Zn deficiency. Normocytic anemia with low TIBC levels may serve as a good indicator of a marginal Zn deficiency.
jimmylegs wrote:great news, FS. check this out:
Chromogenic bacteria cause stains, typically at the gingival margin of the tooth. The most common is a black stain caused by Actinomyces species. The stain is composed of ferric sulfide and is formed by the reaction between hydrogen sulfide produced by bacterial action and iron in the saliva and gingival exudates.
6. What about anemia? Anemias are iron-loading, except for anemias resulting from chronic
blood loss or tumor. When iron accumulates in storage instead being used by hemoglobin,
the patient's hemoglobin will test low. Iron should not be administered. Instead the patient
needs a complex of B vitamins, including B6, folate or folic acid and B12. The excess iron
must be removed despite the anemia.
5. With a hemoglobin of 10 or higher and a hematocrit of 33% or higher, a full unit of blood
should be drawn off once or twice a week. The blood is usable as donor blood when it meets
all safety criteria.
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