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Nutrition in the Older Child
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Sarah Lowry, Jenifer Thompson, Ann O’Shea Scheimann
Iron is a part of hemoglobin and necessary for oxygen transport by the red blood cells. Iron is found in meat products and iron-fortified foods such as cereals. Toddlers are at higher risk of iron deficiency, especially if they drink large amounts of milk (which interferes with iron absorption) and consume low volumes of meat and iron-fortified foods. Children following a vegetarian or vegan diet are also at risk of iron deficiency if iron-rich foods are not part of the daily diet. Iron deficiency is associated with a microcytic anemia and can result in pallor or fatigue.
Etiology of Geophagia
Published in Anil Gupta, Geophagia, 2019
A case was reported by Barton et al. (2016) in which the patient was a woman in the middle age group and a resident of Mumbai, India. The patient had a strong desire to eat uncooked basmati rice. Barton et al. (2016) found that the patient suffered from fatigue, loss of hair, and pallor. The authors observed microcytic anemia and deficiency of iron after laboratory investigation. Barton et al. (2016) managed the patient with an intravenous administration of iron. It was reported by the authors that the habit of pica was discontinued after the initial dose of iron.
Iron Deficiency Anemia
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Donald P. Skoog, James R. Newland
This is a microcytic hypochromic anemia related to iron deficiency due to chronic blood loss from a duodenal leiomyoma. Other causes of microcytic anemia include alpha and beta thalassemia, anemia of chronic disease, and sideroblastic anemia. In adults, chronic blood loss is almost always the cause of IDA, the gastrointestinal tract being the most common source. Young children may develop IDA, so-called milk-and-crackers anemia, while pregnant women may become iron deficient due to fetal demands for iron. There are two general etiologies for microcytic anemia: (a) abnormal iron metabolism, as in this patient; and (b) abnormal globin metabolism, as in the thalassemias and hemoglobin E.
A deep dive into future therapies for microcytic anemias and clinical considerations
Published in Expert Review of Hematology, 2023
François Rodrigues, Tereza Coman, Guillemette Fouquet, Francine Côté, Geneviève Courtois, Thiago Trovati Maciel, Olivier Hermine
Heme synthesis requires three substrates: succinyl-CoA, iron, and glycine. For each heme molecule synthesized, one atom of iron and eight molecules of glycine are needed [65]. It has been shown that reduced delivery of iron to erythroblasts reduces the synthesis of heme. Indeed, as written earlier, the mRNA of aminolevulinic acid synthase 2 (ALAS2), the first-step enzyme of heme production in red blood cells, is regulated by IRPs. In iron-deficiency, IRPs associate with the 5’ UTR IRE region of ALAS2 mRNA to inhibit its translation [15]. Reduced intracellular heme content then activates the heme regulated eIF2alpha kinase (HRI), which represses the translation of globin by phosphorylating the translation initiation factor eIF2 alpha [66]. Decreased heme and globin production thus leads to hypochromic and microcytic anemia in iron deficiency states. Interestingly, the development of microcytic anemia seems necessary for the survival of red blood cells during iron deficiency, as in iron depleted HRI(-/-) mice, globins devoid of heme aggregate within the erythroid lineage, resulting in a hyperchromic, normocytic anemia with decreased RBC counts, compensatory erythroid hyperplasia and accelerated apoptosis in the bone marrow and spleen [67].
Prevalence of Hemoglobinopathies in Premarital Screening in the Province of Nigde, Turkey
Published in Hemoglobin, 2023
Gonul Seyda Seydel, Durmus Ayan, Tevfik Balci, Muhammet Bayraktar, Inayet Gunturk
β-thalassemia is an autosomal recessive inherited disorders characterized by hypochromic microcytic anemia. According to reports, almost 1.5% of the global population (80 to 90 million people) is β-thalassemia carrier and it is highly prevalent in certain regions of the world, such as the Mediterranean, the Middle East, North and Central Africa, and Southeast and Central Asia [20–22]. In Turkey, the prevalence of β-thalassemia carriers is 2.1%, however, this rate varies significantly in various parts of the country, with the highest prevalence in the Mediterranean region (13.1%) [8,23]. Nigde, which is located in the transitive zone between the Central Anatolia and the Mediterranean regions, is scattered among four main provinces including Adana, Mersin, Kayseri, and Konya. Adana and Mersin provinces are located in the Mediterranean region (or Cukurova region), while Konya and Kayseri provinces are located in the Central Anatolia region. In the present study, the prevalence of β-thalassemia carriers was found to be 2.63% in Nigde. In the neighboring provinces of Nigde, the prevalence of β-thalassemia carriers were found as 4.9% in Kadirli (Osmaniye), 2.04% in Mersin, 2.0% in Konya, and 1.7% in Kayseri, respectively [11,14,15,17]. Our results indicate that the prevalence of β-thalassemia carriers in Nigde was slightly higher than the average in Turkey. Besides, in this study, there were four cases with high HbA2 but normal MCV and MCH level. This might be due to coinheritance of β-thalassemia and α-thalassemia carrier states. This has been recognized as a pitfall for screening programs based on MCV/MCH [24,25].
Reticulocyte Hemoglobin Equivalent (Ret-He) Combined with Red Blood Cell Distribution Width Has a Differentially Diagnostic Value for Thalassemias
Published in Hemoglobin, 2019
Yu Lian, Jun Shi, Neng Nie, Zhendong Huang, Yingqi Shao, Jing Zhang, Jinbo Huang, Xingxin Li, Meili Ge, Peng Jin, Min Wang, Yizhou Zheng
Thalassemia traits are diseases of hemoglobin (Hb) synthesis owing to lack of an α chain or β chain product, and are characterized by microcytic hypochromic anemia, which is also observed in another condition, congenital sideroblastic anemia (CSA). Congenital sideroblastic anemia is a rare inherited disorder that commonly demonstrates X-linked inheritance, and presents with hypochromic microcytic anemia due to defects in the synthesis of the heme group, with the presence of ring sideroblasts in the bone marrow [1–3]. The most common microcytic anemia is iron deficiency anemia. In clinical practice, we can definitively diagnose thalassemia trait and CSA using Hb electrophoresis, gene mutations and Prussian blue staining after bone marrow aspirate. These tests, however, are relatively expensive, invasive, and time-consuming. Here, we systemically analyzed the routine blood indexes from the three conditions to determine labor-saving parameters to facilitate the differential diagnosis of thalassemia trait and CSA.