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S E P T E M B E R / O C T O B E R 2 0 0 3
Pumping Iron: Basics Facts About Iron Deficiency
As a nutrition and foodservice consultant,I never know exactly what types of
situations in which I may find myself involved. Recently, I received a call froma company seeking a registered dietitian to design weight loss menus. Ithought it sounded like an interesting project, and at first glance, it appearedto be a pretty simple task. The meals had to meet certain caloric levels and,
of course, 100 percent of the recommended daily allowances (RDA) for vitamins and min-erals. No problem. I dreamed up tasty but convenient meals and delicious snacks. I clippedrecipes and read cookbooks, watched the Food Network, and searched the Internet.
After a few days, I was ready to begin entering my
to body tissues.There are many types and causes of anemia,
menus into a computerized nutrition program that would
but one of the most common types is iron deficiency ane-
perform a detailed analysis of my menus.As I entered the
mia.This condition is a decrease in the number of red cells
last menu, I felt a sense of relief that this task was now
in the blood caused by too little iron. In other words, when
complete.The final step was to check my printouts and
there is too little iron available to produce an adequate
insure that I met the parameters the company desired and
amount of hemoglobin, anemia results.There are many
then finally submit the menus via e-mail. Unfortunately,
causes of iron deficiency anemia including too little iron in
this is when my troubles began. Every single menu was
the diet, poor absorption of iron, and iron lost from the
deficient in iron. My target was 18mg of iron each day, but
body due to blood loss. For example, blood may be lost
I kept coming up short.After hours of recalculating and
due to gastrointestinal bleeding related to ulcers, heavy
making food substitutions, I finally found a few tricks that
menstrual bleeding, and certain types of cancer, particularly
added iron to each meal, but more importantly, I gained a
in the stomach, colon, or esophagus.Table 1 lists the symp-
new appreciation for iron. Now I know why so many peo-
toms of iron deficiency. It is important to note that in mild
ple are iron deficient. It is just not that easy to obtain suffi-
cases of deficiency, no symptoms may be present.
cient iron from common foods. In fact, iron is the nutrientmost commonly deficient in the world affecting approxi-
mately 40 percent of the total population.1 At first glance,
The first step in any diagnosis is a thorough history and
in many nursing homes, it appears that almost every resi-
physical.The clinician should ask about blood loss, medica-
dent is iron deficient. Clearly, iron is one mineral that
tions, such as extended usage of nonsteroidal anti-inflam-
matory drugs (NSAIDs), family history of anemia, anyfatigue-related lifestyle changes, and dietary and supplement
intake. If anemia is suspected, the physical exam should
Iron is the fourth most abundant element in the earth’s
note any splenomegaly, blood in the stool, pallor, and any
crust yet only a trace element in the human body. Iron
other physical symptoms as listed in Table 1.A complete
makes up only 0.0004 percent of the human body’s mass,
blood count (CBC) should be drawn.The laboratory diag-
yet it is an essential component or cofactor of numerous
nosis of iron deficiency anemia includes:
metabolic reactions.2 Iron has many functions in the body,
• Low hemoglobin (Hgb) and hematocrit (Hct)
but perhaps its most important role is as a component of a
• Small red blood cells (microcytic cells)
protein called heme. Iron is necessary to manufacture
hemoglobin, the protein in red blood cells that carries oxy-
gen from the lungs to the body’s tissues. Hemoglobin is the
pigment that gives blood its usual red color. Iron also plays
• Blood in the stool (visible or microcytic).
a role in immune function and cognitive status and many
Many practitioners simply look at Hgb and Hct, but it is
other reactions including the synthesis of DNA, collagen,
important to remember that iron deficiency occurs in
stages.Table 2 outlines the stages of anemia development.
The degree of decrease in Hgb and Hct depends upon the
length of time the bone marrow has been without suffi-
The term anemia
is used to describe many conditions
cient supplies of iron. Other indicators on the CBC should
where red blood cells are not providing adequate oxygen
also be reviewed including mean corpuscular volume
S E P T E M B E R / O C T O B E R 2 0 0 3
iron. In addition, medical nutrition sup-
cating the cells are microcytic or smaller
percentages, reflecting the proportion of
Note: There may be no symptoms if anemia is mild.
decreased in iron deficiency anemia.
1. Adapted from http://www.nlm.nih.gov/medlineplus/ency/article/000584.htm. Last
cause side effects, such as constipation,
very difficult to tolerate. Enteric-coated
they may not be adequately absorbed.
ritin as an initial indicator of iron defi-
Liquid iron tends to stain the teeth, so it
1. Depletion of iron stores, decreased ferritin levels, no anemia
ciency. If iron deficiency is suspected, it
2. Increased transferrin levels, no anemia
ferritin level to supplement the CBC.
4. Development of normocytic, normochromic anemia 5. Development of microcytic, hypochromic anemia
Source1. Rice FA. Iron deficiency anemia. Available at http://www.cariboo.bc.ca/schs/
medtech/rice/irondeficiency.html. Accessed September 9, 2003.
is blood loss, it is important to identify
• Acetohydroxamic acid (e.g., Lithostat): Use with iron supplements may
and vitamin C to increase absorption.
cause either medicine to be less effective
• Antacids: Use with iron supplements may make the iron supplements
enriched flour, lentils, molasses, and oys-
less effective; iron supplements should be taken one or two hours
• Dimercaprol: Iron supplements and dimercaprol may combine in the
ticality, the best food choices for iron are
• Etidronate, fluoroquinolones (e.g., ciprofloxacin, enoxacin, lomefloxacin,
norfloxacin, ofloxacin), or tetracyclines (taken by mouth): Use with iron
supplements may make these medicines less effective; iron supple-
ments should be taken two hours before or after these medicines
• The following foods should be avoided or only taken in very small
amounts for at least one hour before or two hours after you take iron:
Escott-Stump S. Nutrition and Diagnosis-
Related Care, Fifth Edition
. Philadelphia, PA:
Lippincott,Williams, & Wilkins, 2002:472.
1. Available at: http://www.drugs.com/xq/cfm/pageID_0/htm_202305/type_cons/
bn_Iron%20Supplements/micr_medex/qx/index.htm. Accessed September 4, 2003.
Nancy Collins, PhD, RD, LD/N, is a registered and licensed dietitian in
private practice in Pembroke Pines, Florida. For the past 12 years, she has
Rice FA. Iron deficiency anemia.Available
served as a consultant to healthcare institutions on issues regarding regulato-
ry compliance, clinical nutrition, and food service management and as a
medico-legal expert to law firms involved in healthcare litigation.
Correspondence may be sent to Dr. Collins at NCtheRD@aol.com.
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