Iron, TIBC, and Iron Sat %

On May 7, 2010, in Minerals, Tests, by Andrea

It seems people really have trouble understanding iron.  I get it — iron is confusing all to hell.  There’s lots of things that I look at when I am evaluating iron status.  I look at things from the CBC (HCT, HGB, MCH, MCHC, RDW), things from a Hemogram, things from the TIBC, and a Ferritin level.  Sometimes?  I even look at a protein score.  So yes, very, very confusing.

Ranges given are simply given as a point of reference from MY laboratory.  Your lab may use slightly different lab values.  Adapt as necessary.

Many labs consider this a fasting test – but not all.  At the very least, it is best drawn in the morning.

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Dr. Oz on Anemia and Exhaustion

On April 27, 2010, in Minerals, by Andrea

Normally, I have NOTHING for Dr. Oz to do.  Especially since he thinks I’m a drug addict since I’m a chronic pain patient (really, who’s doing my intervention this week?  Sign up sheet’s down the hall..c) but he has a somewhat easy way to explain heme vs. non-heme iron in an animation, plus a very easy way to explain non-iron-deficient anemia (ie just when your hemoglobin is low).  Keep in mind this is not the end-all answer to anemia — but it’s a basic way to help understand some basic iron terminology.

He does make a mistake — most iron supplements do not contain both heme and non-heme iron.  Only one is on the market to my knowledge, and that is Bifera.  Proferrin is the only non-liver-based heme supplement on the market (when it’s not backlogged, that is) that I am aware of currently.  Please note, I found this on his website sponsored BY Bifera.  Imagine that.

Wonder Iron

Did we need a study to prove this?  I mean, really?  (Says the girl fighting back tooth and nail from a ferritin of 7!)

Now, being me, I read the summary first.  And then I read the actual study.  I’ll post the summary first, then the takeaways from the study that I got, and then I’ll post the actual study for those who want to read it.  Cause once I got some key details?  It’s an interesting comparison of information.  Some things that don’t get mentioned..

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FDA takes new look at anemia treatments

On January 8, 2010, in Minerals, by Andrea

I can’t tell you how many RNYers suffer from anemia.  It’s one of the potential side effects given the bypass of the duodenum and the lack of Intrinsic Factor from the stomach that limits the absorption of B12 that is needed for proper iron absorption.  Vicious cycle it is.  Given this, many of us get transfusions and take massive iron doses to help combat the anemia that we suffer from, which makes this a bit more alarming to me.

From Medscape:

U.S. FDA to Take New Look at Anemia Drugs

By Lisa Richwine

WASHINGTON (Reuters) Jan 07 – U.S. regulators plan to ask outside experts to re-evaluate the use of Amgen Inc and Johnson & Johnson anemia drugs when given to patients with chronic kidney disease.

Food and Drug Administration officials, in an article published in the New England Journal of Medicine on Wednesday, said the agency “anticipates convening a public advisory committee meeting in 2010 to reevaluate erythropoiesis-stimulating agents (ESAs) in people with chronic kidney disease.

ESAs include Amgen’s Aranesp and Epogen and J&J’s Procrit.

The drugs came under scrutiny after studies showed high doses could lead to cardiovascular complications or death. Strong warnings were added in recent years and sales slumped, but the medicines remain widely used for patients with kidney disease and cancer.

FDA spokeswoman Karen Riley said an “important question” for the advisory panel would be what level of hemoglobin doctors should try to achieve with the drugs.

The FDA officials, in the journal article, said “optimal hemoglobin targets have never been established” for patients with chronic kidney disease.

“Beyond lowering hemoglobin targets and reducing doses of ESAs, it is also possible that more frequent hemoglobin monitoring” and other dosing changes might “improve outcomes” for patients, the FDA officials said.

They said clinical trials had raised “major concerns regarding the use of ESAs to increase hemoglobin concentrations” in chronic kidney disease patients above levels needed to avert blood transfusions.

But the studies “do not rule out the possibility, however, that modest increases in the hemoglobin level could be beneficial,” they added.

Amgen spokeswoman Emma Hurley said the FDA article “highlights areas of incomplete understanding regarding appropriate use” of ESAs in chronic kidney disease.

The advisory panel meeting will “provide an opportunity to discuss the latest evidence on the benefits and risks” of the medicines, she said.

Centocor Ortho Biotech, the J&J unit that sells Procrit, said in a statement the company “will continue to work with the FDA to ensure that Procrit prescribing information accurately reflects the known benefits and risks of the product, and will continue to communicate this information in a timely fashion.”

New Engl J Med, online January 6, 2010.

Vitamins A-Zinc — B-vitamin Primer

On January 7, 2010, in Vitamins, Water Solubles, by Andrea

The B vitamins are a complex of vitamins that play an important role in many body systems.  Once thought to be a single vitamin and referred to as such (such as vitamins C and D), we now know there are eight separate water-soluble vitamins, each with a different structure and purpose.

B vitamins are necessary for metabolism, neurological health, maintaining healthy skin and muscle tone, immune system health, and promoting cell growth and division — including the red blood cells making them crucial in the role of anemia status.

All B vitamins are water-soluble and most must be replenished regularly as the body excretes excess through the urine.  There are a few exceptions (such as B12) in which the body holds a store that can last even years.

The eight B vitamins are:

B1 – Thiamin(e)
B2 – Riboflavin
B3 – Niacin
B5 – Pantothenic Acid
B7 – Biotin
B9 – Folic Acid
B12 – Cobalamin

Individual B vitamins can be supplemented individually, or in a group as a “B-complex.”

There are additional compounds that were once believed to be vitamins and have similar structure, and thus given names to fill in the gaps of the B vitamin series.  Some are not essential to humans but are to other organisms; others have no nutritional value.

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