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Query: UMLS:C0002871 (anemia)
 52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The invention of recombinant human erythropoietin (rHuEpo) for the treatment of renal anaemia was a hallmark in the care of patients with renal insufficiency. Recently published guidelines (European Best Practice Guidelines, NKF-DOQI) have set the target haemoglobin to be reached by treatment with rHuEpo to >11 g/dl. Normalizing haemoglobin levels may reduce morbidity and mortality and improve quality of life in haemodialysis patients. During long-term treatment, most patients will not respond adequately to therapy with rHuEpo alone. The most important confounding factor, limiting the effectiveness of rHuEpo, is absolute or functional iron deficiency, which is now recognized and treated in many dialysis units. However, there are several other adjuvant treatment options which may help to optimize the response to treatment with rHuEpo. A weekly dose of 2-3 mg of folic acid and 100-150 mg of vitamin B6 is recommended for haemodialysis patients on rHuEpo therapy. The addition of 0.25 mg/month of vitamin B12 may be necessary in selected patients. Vitamin C (1-1.5 g/week) was shown to overcome functional iron deficiency in patients with high ferritin levels. The potential increase of oxidative stress induced by intravenous iron therapy may be blunted by concomitant administration of vitamin E (1200 IU). There is clear evidence from the literature that treatment of secondary hyperparathyroidism by vitamin D improves erythropoiesis. The most recently discovered biological effects of rHuEpo include the induction of several genes in endothelial cells as well as a role for erythropoietin in the outcome of plasmodium infection. A new erythropoietin-like molecule is novel erythropoiesis stimulating protein (NESP), which is as effective and safe as rHuEpo, with the potential advantage of less frequent dosing.
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PMID:Novel aspects of erythropoietin response in renal failure patients. 1150 83

Iron overload could promote the generation of free radicals and result in deleterious cellular damages. A physiological increase of oxidative stress has been observed in pregnancy. A routine iron supplement, especially a combined iron and vitamin C supplementation, without biological justifications (low hemoglobin [Hb] and iron stores) could therefore aggravate this oxidative risk. We investigated the effect of a daily combined iron supplementation (100 mg/d as fumarate) and vitamin C (500 mg/d as ascorbate) for the third trimester of pregnancy on lipid peroxidation (plasma TBARS), antioxidant micronutriments (Zn, Se, retinol, vitamin E, (beta-carotene) and antioxidant metalloenzymes (RBC Cu-Zn SOD and Se-GPX). The iron-supplemented group (n = 27) was compared to a control group (n = 27), age and number of pregnancies matched. At delivery, all the women exhibited normal Hb and ferritin values. In the supplemented group, plasma iron level was higher than in the control group (26.90 +/- 5.52 mmol/L) and TBARs plasma levels were significantly enhanced (p < 0.05) (3.62 +/- 0.36 vs 3.01 +/- 0.37 mmol/L). No significant changes were observed in plasma trace elements and red blood cell antioxidant metalloenzymes. Furthermore, the alpha-tocopherol plasma level was lowered in the iron-supplemented groups, suggesting an increased utilization of vitamin E. These data show that pharmalogical doses of iron, associated with high vitamin C intakes, can result in uncontrolled lipid peroxidation. This is predictive of adverse effects for the mother and the fetus. This study illustrates the potential harmful effects of iron supplementation when prescribed only on the assumption of anemia and not on the bases of biological criteria.
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PMID:Increased lipid peroxidation in pregnant women after iron and vitamin C supplementation. 1176 27

We report a 61-year-old man with vitamin E deficiency, presenting with, myopathy as an only clinical symptom. In 1997, at 59 years of age, he noted mild proxymal-muscle weakness and atrophy in the four extremities, nine years after he received a Billroth II partial gastrectomy for a gastric ulcer. His muscle weakness slowly exacerbated, and he was admitted to our hospital in 1999. On admission, neurological examination confirmed mild proximal-muscle weakness and atrophy in the four extremities. Intelligence, cranial nerves, coordination, sensation and tendon reflexes were all normal. Laboratory examination showed normochromic anemia (Hb 9.9 g/dl, Ht 30.9%, MCV 97.5 fl, MCHC 31.2 pg), hypoproteinemia (5.0 g/dl), and hypocholesterolemia (107 mg/dl). The levels of serum CK, lactate and pyruvate were normal. The serum vitamin E level was markedly reduced (0.17 mg/dl; normal 0.75-1.41). Cerebrospinal fluid was normal. Nerve conduction, sensory evoked potentials (SEP), electromyography (EMG), head CT and electroencephalography (EEG) were all normal. Muscle biopsy from the right deltoid muscle showed both mild myogenic and neurogenic changes. Remarkably, type 1 muscle fiber predominance and granular accumulation of autofluorescent lipofuscin granules in the muscle fibers were found. These pathological findings were compatible with those of vitamin E-deficient myopathy. Thus, he was diagnosed as having vitamin E-deficient myopathy, which was confirmed by apparent effective supplementation of vitamin E. Interestingly, our present case did not show any other neurological manifestations such as deep sensory disturbance, sensory ataxia or polyneuropathy. A long-term workload due to hard physical labor and smoking in our patient may have accelerated oxidative muscle damage, resulting in amyotrophy mainly due to vitamin E deficient myopathy.
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PMID:[A patient with vitamin E deficient, myopathy presenting with amyotrophy]. 1180 55

Malaria is a leading cause of morbidity and mortality worldwide, and anemia is a common and sometimes serious complication of Plasmodium falciparum infection. Although micronutrient malnutrition is usually highly prevalent in malaria endemic areas, the contribution of micronutrient deficiencies to malarial anemia is often overlooked. Recent investigation suggests that micronutrients such as vitamin A, vitamin E, and zinc, may improve the morbidity of malaria through immune modulation and alteration of oxidative stress. Micronutrients are also involved in the pathogenesis of anemia and likely play a role in malarial anemia, but many clinical trials have not specifically addressed the impact of micronutrient supplementation on malarial anemia. Further work is needed to assess the effect of both clinic and community-based micronutrient interventions on malarial anemia in infants, children, and pregnant women.
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PMID:Micronutrient malnutrition and the pathogenesis of malarial anemia. 1203 72

Iron supplementation is essential for adequate response to recombinant human erythropoietin (rHuEPO) or darbepoetin alfa. Oral iron therapy is often ineffective as the quantity of iron absorbed after oral intake may be insufficient to keep pace with the demands of rHuEPO-stimulated erythropoiesis in patients with end-stage renal disease (ESRD). Currently available i.v. iron preparations include dextran, iron gluconate, and iron sucrose. As rare, but serious, adverse reactions to i.v. iron dextran have been reported, alternative preparations may be preferred. Careful monitoring of iron parameters is required to avoid the effects of over-treatment. Renal anaemia and iron therapy are associated with oxidative stress, leading to a shortening of the lifespan of red blood cells (RBC) and resistance to rHuEPO. rHuEPO therapy may also enhance oxidative stress on RBC. Oxidative stress can be attenuated or prevented by supplementation with vitamin E or melatonin. Vitamin E therapy has also been shown to have a rHuEPO-sparing effect. Disturbances of carnitine metabolism may contribute to the development of renal anaemia in ESRD patients. Oral or i.v. L-carnitine therapy results in an increase in haematocrit and a significant decrease in rHuEPO requirement in HD patients. As yet, there is no general recommendation for L-carnitine supplementation for ESRD patients with renal anaemia.
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PMID:Adjunctive therapy in anaemia management. 1209 9

Anaemia in pregnancy is a major public health problem in China. Anaemia in pregnant women may be related to dietary intake of nutrients. To examine the relationship between iron status and dietary nutrients, a cross-sectional study in pregnant women was carried out. The intake of foods and food ingredients were surveyed by using 24-h dietary recall. Blood haemoglobin, haematocrit, serum iron, serum ferritin, transferrin and soluble transferrin receptor were measured in 1189 clinically normal pregnant women in the third trimester of pregnancy. The results showed that the average daily intake of rice and wheat was 504.2 g in the anaemia group and 468.6 g in the normal group. Carbohydrates accounted for 63.69% and 63.09% of energy in the anaemia and normal groups, respectively. Intake of fat was very low; 18.38% of energy in anaemia group and 19.23% of energy in normal group. Soybean intake was 109.4 g/day and 63.6 g/day in the anaemia and normal groups, respectively (P < 0.001). There were lower intakes of green vegetables (172.1 g/day) and fruits (154.9 g/day) in the anaemia group than in the normal group (246.2 g/day green vegetables (P < 0.001) and 196.4 g/day fruit (P < 0.001)). Intakes of retinol and ascorbic acid were much lower in the anaemia than in the normal group (P < 0.001). In the anaemia group, vitamin A intake was only 54.76% of the Chinese recommended daily allowance (RDA) and ascorbic acid intake was 53.35% of the Chinese RDA. Intake of total vitamin E was 14.55 mg/day in the anaemia group compared with 17.35 mg/day in the normal group (P < 0.016). Moreover, intake of iron in pregnant women with anaemia was slightly lower than that in the normal group. Comparison of iron status between the anaemia and normal groups found serum iron in women with anaemia at 0.89 microg/L, which was significantly lower than 1.09 microg/L in the normal group (P < 0.001). There were lower average values of ferritin (14.70) microg/L) and transferrin (3.34 g/L) in the anaemia group than in the normal group (20.40 microg/L ferritin (P < 0.001) and 3.44 g/L transferrin (P < 0.001)). Soluble transferrin receptor was significantly higher (32.90 nmol/L) in the anaemia than in the normal group (23.58 nmol/L; P < 0.001). The results of this study indicate that anaemia might be attributed to a low iron intake, a low intake of enhancers of iron absorption and a high intake of inhibitors of iron absorption from a traditional Chinese diet rich in grains.
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PMID:Iron status and dietary intake of Chinese pregnant women with anaemia in the third trimester. 1223 Feb 29

This review of the nutritional needs of very low birth weight infants (VLBW) concluded that vitamin supplementation was indicated for vitamins A, D, C, and folic acid. With breast feeding or other circumstances, there may be marginal needs for vitamin E, K, B1, B2, and B6. Supplementation of VLBW depends upon the gestation age, which is related to the placental transfer and body stores at birth, and vitamin content of breast milk or formula (feeds), and volume and micronutrient composition of feeds. The infant's vitamin stores at birth are dependent on the nutritional status of the mother, particularly lipid soluble vitamins, which have been found to be higher in fetal cord blood than in maternal blood. The exception is B6, which crosses the placental barrier with difficulty. Preterm infants and infants of undernourished mothers usually have reduced levels of water soluble vitamins at birth. There is some variability in nutrients of feeds. Breast milk, for instance, has lower levels of vitamins D and K than recommended levels. Needs will also very with the presence of particular nutrients. For example, B6 requirements will vary with protein intake. Vitamin E requirements will depend on the amount of linoleic acid or polyunsaturated fatty acids in the diet. Tryptophan in the presence of B6 allows the synthesis of niacin. Volume of feeding affects nutritional needs. The recommended daily allowance (RDA) of specific nutrients for an infant up to 6 month of age and weighing 3-8 kg requires consumption of 500-1000 ml of breast milk or formula per day. A full term infant can receive sufficient nutrients with 450-750 ml, but below 400 would result in a deficit of vitamins. Unfortunately, the volume of feeds for VLBWs is too low in the first two weeks of life or until the body weight of 2000 g is reached; thus supplementation was recommended. Late anemia due to vitamin E deficiency may be prevented when the alpha tocopherol per gram of polyunsaturated fatty acids ratio is equal to or higher than the recommended levels. When intake of vitamin K at birth is insufficient, deficiencies may appear later; the recommendation was .2 to 1.0 mg at birth as a preventive regimen. Vitamin D was also recommended for both breast and formula fed infants. Pyridoxine/ g protein intake, folic acid, and vitamin C should be provided VLBW infants as indicated.
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PMID:Vitamin requirements of very low birth weight infants: a review. 1231 6

A clinic-based cohort study in Kampala, Uganda, was conducted to examine the relationship between severe malarial anaemia and plasma micronutrients. Plasma carotenoids, retinol, vitamin E, and four trace metal concentrations were measured at enrollment and seven days later in 273 children, aged 1-10 year(s), with acute, uncomplicated Plasmodium falciparum malaria. Concentrations of plasma provitamin A carotenoids (p < 0.0001), non-provitamin A carotenoids (p < 0.0001), retinol (p < 0.0001), all four trace elements (all p < 0.001), and vitamin E (p < 0.0001) rose significantly by day 7 among children without severe anaemia (haemoglobin 70 g/L). There was no change in provitamin A carotenoids (p = 0.24) among children with severe anaemia (haemoglobin <70 g/L), whereas non-provitaminAcarotenoids (p < 0.0001), retinol (p < 0.0001), and vitamin E (p = 0.011) increased. These observations also support the hypothesis that the use of provitamin A carotenoids increases during malaria infection.
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PMID:Relationship between carotenoids and anaemia during acute uncomplicated Plasmodium falciparum malaria in children. 1243 Jul 56

Reduced red blood cell (RBC) survival due to oxidative damage is one of the causes of anemia in patients under long-term hemodialysis. Recently, it has been shown that vitamin E-bonded dialyzer membrane is able to reduce the oxidative stress during hemodialysis. In humans, creatine content in RBC is used to measure RBC life span and erythropoietic capacity, since it rapidly declines as the RBCs become old. Therefore this study aimed to elucidate the effect of vitamin E-bonded dialyzer membrane on RBC life span by measuring creatine content in RBC.
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PMID:The effect of vitamin E-bonded dialyzer membrane on red blood cell survival in hemodialyzed patients. 1266 4

Non-healing wounds are a common cause of morbidity worldwide. The wounds are the result of inadequate repair in an optimum period and are due to the presence of predisposing factors. The abnormalities of certain biochemical factors are important in impeding wound healing. One hundred patients with non-healing wounds of more than six weeks duration were studied for nutritional and vitamin status and their correlation with healing time. The healing time was significantly prolonged in patients with serum protein concentrations below 6 gram/dl, but the healing time was not correlated with the concentrations of vitamin C or vitamin E. Anemia also did not alter the healing time. Adequate protein intake is the most important prerequisite for good wound healing.
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PMID:Nutritional and vitamin status of non-healing wounds in patients attending a tertiary hospital in India. 1269 75


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