ascorbic-acid and Anemia

Iron deficiency anemia (IDA) is one of the leading causes of anemia, globally. Oral vitamin C enhances iron absorption and is commonly prescribed with iron for anemia patients. Considering the lack of evidence to support this practice, we conducted this systematic review and meta-analysis to determine the treatment efficacy of experimental studies where oral vitamin C or ascorbate was given as co-intervention with iron compared to providing only iron among participants with anemia of all ages.. A comprehensive strategy was used to search literature from PubMed, Cochrane and Google Scholar. Experimental studies conducted among participants with lab-confirmed anemia at baseline, with "oral ascorbic acid or vitamin C given as co-intervention with iron" as intervention and "only oral iron" as the comparator, and reported the outcomes hemoglobin or ferritin, were selected. Random-effects model was used to estimate standardized mean differences or odds ratio of outcomes, and sensitivity analyses were done. Sub-group and meta-regression analyses were conducted to evaluate the reasons for heterogeneity (PROSPERO number: CRD42022306612).. Of the total nine studies included in the review, seven studies with 905 participants were included for meta-analysis. The pooled estimate for standardized mean difference (SMD) of hemoglobin (g/dL) and Serum Ferritin (mcg/L) for intervention-type ferrous ascorbate were 0.44 (95% C.I.: -0.30, 1.26) and 0.03 (95% C.I.: -0.68, 0.73) respectively, and were not statistically significant. The pooled estimate for SMD of hemoglobin (g/dL) and Serum Ferritin (mcg/L) for intervention type 'oral iron and vitamin C' was 0.11 (95% C.I.: -0.05, 0.28) and -0.90 (95% C.I.: -1.09, -0.72) respectively, and were not statistically significant.. The SMD of hemoglobin or serum ferritin between the intervention group were not significantly favouring the intervention when the intervention group was ferrous ascorbate or oral iron and vitamin C, and the methodological quality of evidence of these effect measures was very low. This necessitates studying the treatment efficacy of oral vitamin C or ascorbate when given with oral iron for participants with anemia in future clinical trials.

Topics: Anemia; Ascorbic Acid; Ferritins; Humans; Iron; Treatment Outcome; Vitamins

Vitamin C supplementation may help reduce the risk of pregnancy complications such as pre-eclampsia, intrauterine growth restriction and maternal anaemia. There is a need to evaluate the efficacy and safety of vitamin C supplementation in pregnancy.. To evaluate the effects of vitamin C supplementation, alone or in combination with other separate supplements on pregnancy outcomes, adverse events, side effects and use of health resources.. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015) and reference lists of retrieved studies.. All randomised or quasi-randomised controlled trials evaluating vitamin C supplementation in pregnant women. Interventions using a multivitamin supplement containing vitamin C or where the primary supplement was iron were excluded.. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.. Twenty-nine trials involving 24,300 women are included in this review. Overall, 11 trials were judged to be of low risk of bias, eight were high risk of bias and for 10 trials it was unclear. No clear differences were seen between women supplemented with vitamin C alone or in combination with other supplements compared with placebo or no control for the risk of stillbirth (risk ratio (RR) 1.15, 95% confidence intervals (CI) 0.89 to 1.49; 20,038 participants; 11 studies; I² = 0%; moderate quality evidence), neonatal death (RR 0.79, 95% CI 0.58 to 1.08; 19,575 participants; 11 studies; I² = 0%), perinatal death (average RR 1.07, 95% CI 0.77 to 1.49; 17,105 participants; seven studies; I² = 35%), birthweight (mean difference (MD) 26.88 g, 95% CI -18.81 to 72.58; 17,326 participants; 13 studies; I² = 69%), intrauterine growth restriction (RR 0.98, 95% CI 0.91 to 1.06; 20,361 participants; 12 studies; I² = 15%; high quality evidence), preterm birth (average RR 0.99, 95% CI 0.90 to 1.10; 22,250 participants; 16 studies; I² = 49%; high quality evidence), preterm PROM (prelabour rupture of membranes) (average RR 0.98, 95% CI 0.70 to 1.36; 16,825 participants; 10 studies; I² = 70%; low quality evidence), term PROM (average RR 1.26, 95% CI 0.62 to 2.56; 2674 participants; three studies; I² = 87%), and clinical pre-eclampsia (average RR 0.92, 95% CI 0.80 to 1.05; 21,956 participants; 16 studies; I² = 41%; high quality evidence).Women supplemented with vitamin C alone or in combination with other supplements compared with placebo or no control were at decreased risk of having a placental abruption (RR 0.64, 95% CI 0.44 to 0.92; 15,755 participants; eight studies; I² = 0%; high quality evidence) and had a small increase in gestational age at birth (MD 0.31, 95% CI 0.01 to 0.61; 14,062 participants; nine studies; I² = 65%), however they were also more likely to self-report abdominal pain (RR 1.66, 95% CI 1.16 to 2.37; 1877 participants; one study). In the subgroup analyses based on the type of supplement, vitamin C supplementation alone was associated with a reduced risk of preterm PROM (average RR 0.66, 95% CI 0.48 to 0.91; 1282 participants; five studies; I² = 0%) and term PROM (average RR 0.55, 95% CI 0.32 to 0.94; 170 participants; one study). Conversely, the risk of term PROM was increased when supplementation included vitamin C and vitamin E (average RR 1.73, 95% CI 1.34 to 2.23; 3060 participants; two studies; I² = 0%). There were no differences in the effects o. The data do not support routine vitamin C supplementation alone or in combination with other supplements for the prevention of fetal or neonatal death, poor fetal growth, preterm birth or pre-eclampsia. Further research is required to elucidate the possible role of vitamin C in the prevention of placental abruption and prelabour rupture of membranes. There was no convincing evidence that vitamin C supplementation alone or in combination with other supplements results in other important benefits or harms.

Topics: Anemia; Ascorbic Acid; Dietary Supplements; Female; Fetal Growth Retardation; Humans; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Randomized Controlled Trials as Topic; Vitamins

Ascorbate is a cofactor in numerous metabolic reactions. Humans cannot synthesize ascorbate owing to inactivation of the gene encoding the enzyme l-gulono-γ-lactone oxidase, which is essential for ascorbate synthesis. Accumulating evidence strongly suggests that in addition to the known ability of dietary ascorbate to enhance nonheme iron absorption in the gut, ascorbate within mammalian systems can regulate cellular iron uptake and metabolism. Ascorbate modulates iron metabolism by stimulating ferritin synthesis, inhibiting lysosomal ferritin degradation, and decreasing cellular iron efflux. Furthermore, ascorbate cycling across the plasma membrane is responsible for ascorbate-stimulated iron uptake from low-molecular-weight iron-citrate complexes, which are prominent in the plasma of individuals with iron-overload disorders. Importantly, this iron-uptake pathway is of particular relevance to astrocyte brain iron metabolism and tissue iron loading in disorders such as hereditary hemochromatosis and β-thalassemia. Recent evidence also indicates that ascorbate is a novel modulator of the classical transferrin-iron uptake pathway, which provides almost all iron for cellular demands and erythropoiesis under physiological conditions. Ascorbate acts to stimulate transferrin-dependent iron uptake by an intracellular reductive mechanism, strongly suggesting that it may act to stimulate iron mobilization from the endosome. The ability of ascorbate to regulate transferrin iron uptake could help explain the metabolic defect that contributes to ascorbate-deficiency-induced anemia.

Topics: Anemia; Animals; Ascorbic Acid; Astrocytes; Basic Helix-Loop-Helix Transcription Factors; beta-Thalassemia; Biological Transport; Erythropoiesis; Ferritins; Hemochromatosis; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Iron; Transferrin

Patients on dialysis often develop anemia, which is accompanied by the development of substantial iron stores after administration of intravenous iron. This can be remedied in some instances with administration of supplemental vitamin C, either intravenously or orally. This is because of the mobilization of stored iron, which results in correction of anemia and in improvement of iron-indices of red cells and reticulocytes. The short red cell survival often seen in patients on dialysis creates a situation in which very large amounts of iron are needed to be supplied for new erythropoiesis, and vitamin C therefore contributes to necessary iron delivery. The safety of this therapy needs careful study so as to determine vitamin C dosage that is effective and also avoids complications of oxalosis.

Topics: Anemia; Ascorbic Acid; Dietary Supplements; Humans; Kidney Failure, Chronic; Renal Dialysis; Vitamins

To determine the impact of adjuvant ascorbic acid therapy on erythropoietin-hyporesponsive, anemic patients undergoing hemodialysis.. The online databases of PubMed, Cochrane library, IPA, CINAHL, EMBASE, clinicaltrial.gov, WHO trial registry and PyschINFO were used.. Studies comparing ascorbic acid to a control, with participants receiving erythropoietin and hemodialysis, and reported outcomes for hemoglobin or transferring saturation.. Two independent researchers reviewed titles and abstracts to determine relevance and extracted study design, dose, duration, baseline values, and outcomes.. Five studies met all the criteria and were used for final analysis. The calculated weighted mean difference between hemoglobin in the ascorbic acid group versus the control group was 0.96 g/dL (95% CI, 0.78 to 1.14). The calculated weighted mean difference between transferrin saturation in the ascorbic acid treatment group versus the control was 8.26% (95% CI, 6.59 to 9.94).. Adjuvant ascorbic acid significantly raises hemoglobin levels in patients with erythropoietin hyporesponsiveness undergoing hemodialysis. The significant rise in transferrin saturation indicates that this positive effect on erythropoietin response may be due to increased iron utilization.

Topics: Adult; Anemia; Antioxidants; Ascorbic Acid; Erythropoietin; Female; Hemoglobins; Humans; Injections, Intravenous; Iron; Iron Overload; Kidney Failure, Chronic; Male; Middle Aged; Randomized Controlled Trials as Topic; Renal Dialysis

Ascorbic acid is believed to improve anemia in patients with end-stage renal disease, but its overall effectiveness is unclear.. Systematic review and meta-analysis.. Adult hemodialysis patients.. Randomized clinical trials of ascorbic acid use in addition to standard anemia management.. Ascorbic acid.. Weighted mean difference (WMD) for change in hemoglobin level, recombinant human erythropoietin (rHuEPO) dose, transferrin saturation and ferritin level and adverse events.. Of 157 potentially relevant studies, 6 studies (n = 326 patients) met the inclusion criteria. Combining the 3 randomized clinical trials involving patients with baseline hemoglobin levels <11 g/dL, change in hemoglobin level was greater for ascorbic acid use compared with standard care (WMD, 0.9 g/dL; 95% CI, 0.5-1.2 g/dL). Compared with standard care, ascorbic acid use also was associated with a statistically significant decrease in rHuEPO dose (WMD, -17.1 U/kg/wk; 95% CI, -26.0 to -8.2 U/kg/wk) and improvement in transferrin saturation (WMD, 7.9%; 95% CI, 5.2-10.5%), with no change in ferritin concentration. Adverse events had questionable relevance to ascorbic acid use; no study reported oxalate levels or occurrence of oxalosis.. Small number of studies, heterogeneity between study populations, and study durations were short. Adverse events were poorly reported.. Although the studies are limited by small numbers of subjects, short durations of follow-up, and variable quality, these results suggest that compared with standard care, ascorbic acid use may result in an increase in hemoglobin concentration and transferrin saturation and decrease in rHuEPO requirements. Longer term studies are required to confirm these results, provide information about adverse events, and determine whether these changes translate into improved patient outcomes and cost-effectiveness.

Topics: Adult; Anemia; Ascorbic Acid; Dose-Response Relationship, Drug; Hemoglobins; Humans; Kidney Failure, Chronic; Middle Aged; Renal Dialysis; Treatment Outcome

It has been widely established that patients with end-stage renal disease undergoing chronic haemodialysis therapy exhibit low endogenous levels of L-carnitine and elevated acylcarnitine levels; however, the clinical implication of this altered carnitine profile is not as clear. It has been suggested that these disturbances in carnitine homeostasis may be associated with a number of clinical problems common in this patient population, including erythropoietin-resistant anaemia, cardiac dysfunction, and dialytic complications such as hypotension, cramps and fatigue. In January 2003, the Centers for Medicare and Medicaid Services (USA) implemented coverage of intravenous L-carnitine for the treatment of erythropoietin-resistant anaemia and/or intradialytic hypotension in patients with low endogenous L-carnitine concentrations. It has been estimated that in the period of 1998-2003, 3.8-7.2% of all haemodialysis patients in the USA received at least one dose of L-carnitine, with 2.7-5.2% of patients receiving at least 3 months of supplementation for one or both of these conditions. The use of L-carnitine within Australia is virtually non-existent, which leads us to the question: Are Australian haemodialysis patients missing out? This review examines the previous research associated with L-carnitine administration to chronic dialysis patients for the treatment of anaemia, cardiac dysfunction, dyslipidaemia and/or dialytic symptoms, and discusses whether supplementation is warranted within the Australian setting.

Topics: Anemia; Ascorbic Acid; Carnitine; Follow-Up Studies; Humans; Kidney Failure, Chronic; Prevalence; Renal Dialysis; South Australia; Treatment Outcome; Vitamin B Complex; Vitamins; Western Australia

Provision of sufficient available iron is a prerequisite to ensure the bodys optimal response to recombinant human erythropoietin (epoetin). Functional iron deficiency (a state when iron supply is reduced to meet the demands for increased erythropoiesis) is a common cause of poor response to epoetin in dialysis patients who have normal iron status, even when they are iron-overloaded. Iron supplementation is not justified for this hyporesponsiveness in patients with iron overload due to the potential hazards of iron overload aggravated by intravenous iron therapy. Furthermore, in vivo studies have indicated that the promising effect of intravenous iron medication to overcome iron-deficient erythropoiesis is not observed in iron-overloaded hemodialysis (HD) patients. Vitamin C, a water-soluble antioxidant as well as a reducing agent, has a number of associations with iron metabolism. Recent research highlights that vitamin C can potentiate the mobilization of iron from inert tissue stores and facilitates the incorporation of iron into protoporphyrin in HD patients being treated with epoetin. Interest has turned towards the use of vitamin C as an adjuvant therapy in this field. This review focuses on the improvement of epoetin response by administration of vitamin C and discusses its clinical implications and potential issues for internal medicine doctors.

Topics: Administration, Oral; Anemia; Ascorbic Acid; Erythropoietin; Humans; Injections, Intravenous; Recombinant Proteins; Renal Dialysis

Anemia prevention for hemodialysis relies primarily on supplemental erythropoietin (EPO) and intravenous iron (IV-iron). The doses of EPO utilized are somewhat higher than normal endogenous rates of EPO production in healthy subjects, and the amount of IV-iron used to boost red blood cell (RBC) production may be greater than the amounts used for erythropoiesis. EPO and IV-iron might be used more efficiently if two fundamental problems were solved in the management of dialysis patients: better vitamin C status, and avoidance of chronic inflammation. The low levels of plasma vitamin C commonly observed in dialysis patients restrict mobilization of stored iron from the reticuloendothelial system (RES), and inflammation has a very similar effect. The impact of low vitamin C levels and concurrent inflammation causes a large amount of iron to be stored, with relatively inefficient utilization for erythropoiesis. Vitamin C intake for dialysis patients is often restricted because of avoidance of vitamin C-rich foods, and because of concerns about oxalosis. Inflammation is a chronic feature of renal disease, which is compounded by infections from use of catheters. Research strategies to improve vitamin C status and to decrease inflammation would lead to better utilization of iron and EPO, and could have parallel benefits for the long-term health of patients on hemodialysis.

Topics: Anemia; Ascorbic Acid; Ascorbic Acid Deficiency; Hematopoiesis; Humans; Kidney Failure, Chronic; Renal Dialysis

Topics: Anemia; Angiotensin-Converting Enzyme Inhibitors; Ascorbic Acid; Drug Design; Erythropoietin; Hematinics; Humans; Iron; Japan; Kidney Failure, Chronic; Practice Guidelines as Topic; Prognosis; Quality of Life; Recombinant Proteins; Renal Dialysis

Adjuvant therapy may allow patients being treated with epoetin to derive greater clinical benefits. Iron supplementation is currently the most widely used form of adjuvant therapy; intravenous (i.v.) iron is required by the majority of haemodialysis patients receiving epoetin. Measurement of hypochromic red blood cells is the most direct way of assessing iron supply to the bone marrow. During the correction phase, a dose of i.v. iron equivalent to 50 mg/day is recommended, with the total dose not exceeding 3 g. When subclinical vitamin C deficiency is suspected, ascorbic acid may be given orally (1-1.5 g/week) or i.v. (300 mg three times weekly at the end of dialysis). The active vitamin D metabolites alfacalcidol and calcitriol may, under some circumstances, improve anaemia and reduce epoetin dosage requirements. Vitamin B6 requirements are increased during epoetin therapy, and supplementation at a dose of 100-150 mg/week is recommended. Supplementation of vitamin B12 is optional. Folic acid is supplemented routinely in haemodialysis patients, though evidence that it increases the efficacy of epoetin is limited. Low doses (2-3 mg/week) should normally be sufficient to maintain optimal folic acid stores in epoetin-treated patients, although higher doses are necessary for patients with hyperhomocysteinaemia. L-Carnitine supplementation may be appropriate in some patients with anaemia of chronic renal failure (CRF) unresponsive to, or requiring large doses of, epoetin. Androgens potentially could reduce epoetin costs in countries with limited resources, but should only be used in men older than 50 years with a remnant kidney. Recent animal studies indicate that the combination of epoetin and insulin-like growth factor 1 might be beneficial in CRF patients. High doses of angiotensin-converting enzyme (ACE) inhibitors should be reserved for dialysis patients who have hypertension that cannot be controlled by other agents, or who require an ACE inhibitor for treatment of heart failure.

Topics: Androgens; Anemia; Angiotensin-Converting Enzyme Inhibitors; Ascorbic Acid; Carnitine; Cytokines; Erythropoietin; Humans; Iron; Kidney Failure, Chronic; Pyridoxine; Vitamin D

The generation of reactive oxygen species (ROS) is a steady-state cellular event in respiring cells. Their production can be grossly amplified in response to a variety of pathophysiological conditions such as inflammation, immunologic disorders, hypoxia, hyperoxia, metabolism of drug or alcohol, exposure to UV or therapeutic radiation, and deficiency in antioxidant vitamins. Uncontrolled production of ROS often leads to damage of cellular macromolecules (DNA, protein, and lipids) and other small antioxidant molecules. A number of major cellular defense mechanisms exist to neutralize and combat the damaging effects of these reactive substances. The enzymic system functions by direct or sequential removal of ROS (superoxide dismutase, catalase, and glutathione peroxidase), thereby terminating their activities. Metal binding proteins, targeted to bind iron and copper ions, ensure that these Fenton metals are cryptic. Nonenzymic defense consists of scavenging molecules that are endogenously produced (GSH, ubiquinols, uric acid) or those derived from the diet (vitamins C and E, lipoic acid, selenium, riboflavin, zinc, and the carotenoids). These antioxidant nutrients occupy distinct cellular compartments and among them, there are active recycling. For example, oxidized vitamin E (tocopheroxy radical) has been shown to be regenerated by ascorbate, GSH, lipoic acid, or ubiquinols. GSH disulfides (GSSG) can be regenerated by GSSG reductase (a riboflavin-dependent protein), and enzymic pathways have been identified for the recycling of ascorbate radical and dehydroascorbate. The electrons that are used to fuel these recycling reactions (NADH and NADPH) are ultimately derived from the oxidation of foods. Sickle cell anemia, thalassemia, and glucose-6-phosphate-dehydrogenase deficiency are all hereditary disorders with higher potential for oxidative damage due to chronic redox imbalance in red cells that often results in clinical manifestation of mild to serve hemolysis in patients with these disorders. The release of hemoglobin during hemolysis and the subsequent therapeutic transfusion in some cases lead to systemic iron overloading that further potentiates the generation of ROS. Antioxidant status in anemia will be examined, and the potential application of antioxidant treatment as an adjunct therapy under these conditions will be discussed.

Topics: Anemia; Anemia, Sickle Cell; Animals; Antioxidants; Ascorbic Acid; Glucosephosphate Dehydrogenase Deficiency; Humans; Nutrition Disorders; Oxidative Stress; Thalassemia; Vitamin E

Optimizing the use of recombinant human erythropoietin (r-HuEPO) involves choosing an appropriate dose regimen and target haemoglobin level, addressing factors that inhibit response, and considering appropriate adjuvant therapy. Subcutaneous administration of r-HuEPO two or three times weekly is optimal for most patients. Early detection and treatment of iron deficiency is mandatory. Measurement of the percentage of hypochromic red blood cells is a reliable marker of functional iron deficiency, and the treatment of choice is intravenous iron. Other factors that can affect the response to r-HuEPO include blood loss (sometimes occult), infection, inflammation, hyperparathyroidism with marrow fibrosis, aluminium toxicity, vitamin B12/folate deficiency, haemolysis, bone marrow disorders, haemoglobinopathies, under-dialysis and possibly angiotensin-converting enzyme inhibitors. These factors should be identified and corrected where possible. Ascorbic acid, vitamin D, folic acid, carnitine, other cytokines and growth factors have all been shown to augment the response to r-HuEPO in some patients. Further research is required before any of these adjuvant therapies can be incorporated into routine clinical practice. With regard to target haemoglobin value, the current practice is to aim for a level of 10-12 g/dl, but it may be argued that a higher target would achieve greater benefits in terms of physical performance, quality of life, and possibly cardiac morbidity and mortality. International multicentre trials are currently in progress to address this issue, as are studies on other substances that may be able to stimulate erythropoiesis.

Topics: Anemia; Ascorbic Acid; Carnitine; Clinical Trials as Topic; Cytokines; Drug Administration Schedule; Erythropoietin; Folic Acid; Growth Substances; Hemoglobins; Humans; Injections, Intravenous; Injections, Subcutaneous; Iron; Iron Deficiencies; Kidney Failure, Chronic; Recombinant Proteins; Renal Dialysis; Vitamin D

Topics: Anemia; Animal Feed; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Caniformia; Deficiency Diseases; Dolphins; Fishes, Poisonous; Histamine; Hyponatremia; Lactose Intolerance; Seals, Earless; Thiamine Deficiency; Vitamin E Deficiency

Topics: Anemia; Ascorbic Acid; Blood Coagulation Disorders; Chronic Disease; Folic Acid; Hematologic Diseases; Hemolysis; Humans; Leukocytosis; Mononuclear Phagocyte System; Serum Albumin; Stress, Physiological; Syndrome; Thrombocytosis; Zinc

Topics: Adolescent; Adult; Aged; Anemia; Ascorbic Acid; Deferoxamine; Drug Evaluation; Feces; Humans; Iron; Leukocytes; Thalassemia

Topics: Adult; Age Factors; Anemia; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Bone Diseases, Developmental; Capillaries; Child; Collagen Diseases; Connective Tissue; Creatinine; Dentin; Gingival Hemorrhage; Hemorrhage; Humans; Hydroxyproline; Infant; Scurvy; Skin Diseases; Species Specificity

Topics: Aging; Agranulocytosis; Anemia; Animals; Ascorbic Acid; Cicatrix; Collagen; Contracture; Drainage; Endothelium; Fibroblasts; Foreign Bodies; Granulation Tissue; Hematoma; Humans; Neutrophils; Protein Deficiency; Recurrence; Skin; Steroids; Stress, Mechanical; Surgical Procedures, Operative; Wound Healing; Wound Infection

Topics: Anemia; Animals; Ascorbic Acid; Biomechanical Phenomena; Cicatrix; Collagen; Denervation; Fibrin; Fibroblasts; Glucocorticoids; Glycoproteins; Glycosaminoglycans; Granulation Tissue; Guinea Pigs; Histamine; Humans; Lathyrism; Microbial Collagenase; Oxygen; Rabbits; Rats; Species Specificity; Stress, Physiological; Time Factors; Wound Healing; Wounds and Injuries

Topics: Adolescent; Adult; Aged; Anemia; Ascorbic Acid; Body Height; Body Weight; Child; Child, Preschool; Diet; Dietary Proteins; Ethnicity; Female; Humans; Infant; Male; Middle Aged; Nicotinic Acids; Nutrition Disorders; Nutrition Surveys; Riboflavin; Thiamine; United States; Vitamins

Topics: Anemia; Animals; Ascorbic Acid; Ceruloplasmin; Chelating Agents; Copper; Endoplasmic Reticulum; Hemoglobins; Hepatolenticular Degeneration; Humans; Iron; Kinetics; Models, Biological; Models, Chemical; Oxidoreductases; Transferrin

Topics: Abetalipoproteinemia; Adult; Anemia; Anemia, Macrocytic; Animals; Ascorbic Acid; Bone Marrow; Deficiency Diseases; Dietary Fats; DNA Replication; Erythropoiesis; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Iron; Kwashiorkor; RNA; Salmonidae; Selenium; Swine; Vitamin B 12; Vitamin E; Vitamin E Deficiency

Topics: Altitude; Anemia; Anemia, Macrocytic; Anemia, Sickle Cell; Ascorbic Acid; Celiac Disease; Climate; Deficiency Diseases; Female; Folic Acid; Hematology; Humans; Infant; Metabolism; Nutrition Disorders; Parasitic Diseases; Pharmaceutical Preparations; Poisons; Polycythemia; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Radiation Effects; Seasons; Sprue, Tropical; Vitamin B 12

Administration of intravenous vitamin C in hemodialysis patients can reduce their ferritin levels. Nevertheless, little research has been carried out in this regard. Hence, this study aimed to determine the effect of intravenous vitamin C on ferritin levels in a group of hemodialysis patients.. The study population included 32 patients with chronic renal failure undergoing hemodialysis who had been referred to Qazvin Hospital. These patients had functional iron deficiency (IDA) and high levels of serum ferritin. Patients were randomly allocated into intervention group A (n = 16) and control group B (n = 16). Group A was given intravenous ascorbic acid, while group B was given the same amount of distilled water as a placebo three times a week after each dialysis session for three months along with erythropoietin. Laboratory parameters were assessed at the beginning and the end in an interval of three months.. In patients who received vitamin C injections, the mean ferritin level decreased at the end of the study (P < .05). But vitamin C intake did not affect BUN, creatinine, sodium, potassium, TIBC, hemoglobin, platelets count, and the length and number of dialysis sessions.. Results of our study showed that vitamin C can reduce serum ferritin levels in hemodialysis patients. Therefore, it can be used as an adjunct in the treatment of anemia in patients.  DOI: 10.52547/ijkd.6531.

Topics: Anemia; Ascorbic Acid; Erythropoietin; Female; Ferritins; Hemoglobins; Humans; Kidney Failure, Chronic; Male; Renal Dialysis; Vitamins

We evaluate the effect of the protoconized anemia therapy on adverse events using the Hb and ferritin levels of individual patients undergoing maintenance hemodialysis (MHD).. Design: A randomized, parallel group, multi-center study.. Two hundred sixty-six MHD patients. Intervention group: The doses of erythropoietin, iron, and vitamin C were adjusted every month based on the ferritin and hemoglobin (Hb) levels according to the protocol. Non-intervention group: The attending physician determined the doses of erythropoietin and iron.. The maintenance rate of target Hb and ferritin levels were significantly higher in the Intervention group than in the Non-intervention group. The frequency of hospitalization was significantly lower for patients with a higher maintenance rate of target Hb levels than for those with a lower maintenance rate.. Using an anemia treatment protocol according to the individual Hb and ferritin levels of hemodialysis patients might stabilize the Hb and ferritin levels, which in turn could contribute to the lower frequency of adverse events in MHD patients.

Topics: Adult; Aged; Anemia; Ascorbic Acid; Biomarkers; Drug Dosage Calculations; Drug Monitoring; Drug Therapy, Combination; Erythropoietin; Female; Ferritins; Hematinics; Hemoglobins; Hospitalization; Humans; Iron; Japan; Kidney Failure, Chronic; Male; Middle Aged; Predictive Value of Tests; Renal Dialysis; Time Factors; Treatment Outcome

The present study was aimed at assessing the effect of zinc- and micronutrient-rich food supplementation compared with ayurvedic zinc tablets on the blood levels of zinc and vitamin A in adolescent girls.. One hundred eighty apparently healthy schoolgirls (12.5 ± 0.85 y old) were recruited for a 10-wk intervention trial. They were randomized to three groups: one group received a food supplement that was prepared using zinc- and micronutrient-rich foods and by adopting food-processing methods that increase zinc bioavailability; the second group received ayurvedic zinc (Jasad) tablets as a natural elemental zinc supplement; and the third group served as the control without any supplementation. Diet was assessed by 24-h recall on 3 non-consecutive days. Fasting blood samples were analyzed for plasma levels of zinc, β-carotene, retinol, vitamin C, and hemoglobin at baseline and the end of the study period.. Food supplementation showed a significant increase in plasma levels of zinc (9.9%), β-carotene (56.2%), and vitamin C (28.0%, P < 0.05) and a non-significant increase in hemoglobin (1.7%), although small, non-significant changes in blood micronutrient levels were observed in the control group (P > 0.1). Food supplementation decreased the prevalence of zinc deficiency (73% to 53.1%), β-carotene deficiency (31.1% to 17.4%), and mild anemia (32.2% to 23.7%). Ayurvedic zinc supplementation significantly improved plasma zinc (61.3%) and plasma retinol (38.2%) and decreased the prevalence of zinc deficiency (73.7% to 36.2%) and vitamin A deficiency (65.4% to 20.4%, P < 0.05).. Zinc- and micronutrient-rich food supplementation was effective in improving the zinc and vitamin A status of adolescent girls.

Topics: Adolescent; Anemia; Ascorbic Acid; beta Carotene; Biological Availability; Child; Dietary Supplements; Female; Hemoglobins; Humans; Micronutrients; Nutritional Status; Vitamin A; Vitamin A Deficiency; Zinc

Although erythropoietin (EPO)-hyporesponsive anemia in hemodialysis patients most commonly results from iron deficiency, the contributory role of chronic inflammation and oxidative stress in its pathogenesis is poorly understood. We conducted an open-label prospective study to assess the effect of vitamin C, an antioxidant, on EPO-hyporesponsive anemia in hemodialysis patients with unexplained hyperferritinemia.. Forty-six of 262 patients in an inner-city hemodialysis center met the inclusion criteria (administration of intravenous iron and EPO for > or = 6 months at a dose > or = 450 U/kg/wk, average 3-month hemoglobin [Hb] level < or = 11.0 g/dL [< or = 110 g/L], ferritin level > or = 500 ng/mL (microg/L), and transferrin saturation [TSAT] < or = 50%). Patients were excluded if they had a clear explanation for the EPO hyporesponsiveness. Four patients refused to participate. The remaining patients were randomly assigned; 20 patients to receive standard care and 300 mg of intravenous vitamin C with each dialysis session (group 1) and 22 patients to receive standard care only (group 2). Study duration was 6 months. During the study, 1 patient from group 1 was removed (upper gastrointestinal bleeding) from final analysis. Monthly assessment included Hb level, mean corpuscular volume, iron level, iron-binding capacity, ferritin level, TSAT, and Hb content in reticulocytes. In addition, biointact parathyroid hormone, aluminum, C-reactive protein (CRP), and liver enzymes were measured every 3 months.. Age, sex, race, and time on dialysis therapy were similar in both groups. At 6 months, Hb levels significantly increased from 9.3 to 10.5 g/dL (93.0 to 105.0 g/L) in group 1, but not group 2 (9.3 to 9.6 g/dL [93.0 to 96.0 g/L]; P = 0.0001). Similarly, TSAT increased from 28.9% to 37.3% in group 1, but not group 2 (28.7% to 29.3%; P = 0.0001). EPO dose (477 to 429 versus 474 to 447 U/kg/wk), iron-binding capacity (216 to 194 versus 218 to 257 microg/dL [38.7 to 34.7 versus 39 to 46 micromol/L]), and CRP level (2.8 to 0.9 versus 2.8 to 2.2 mg/dL) decreased significantly in group 1, but not in controls. Changes in Hb content in reticulocytes and ferritin level also were statistically significant in group 1. There was no change in biointact parathyroid hormone levels. Although serum iron levels and intravenous iron doses changed within each group, changes were equal between the 2 groups.. In hemodialysis patients with refractory anemia and hyperferritinemia, vitamin C improved responsiveness to EPO, either by augmenting iron mobilization from its tissue stores or through antioxidant effects.

Topics: Adult; Anemia; Antioxidants; Ascorbic Acid; Erythropoietin; Female; Ferritins; Humans; Injections, Intravenous; Iron Metabolism Disorders; Kidney Failure, Chronic; Male; Middle Aged; Prospective Studies; Renal Dialysis

Chronic hemodialysis (HD) patients increase erythrocyte susceptibility to hemolysis and impair cell survival. We explored whether electrolyte-reduced water (ERW) could palliate HD-evoked erythrocyte impairment and anemia. Forty-three patients undergoing chronic HD were enrolled and received ERW administration for 6 month. We evaluated oxidative stress in blood and plasma, erythrocyte methemoglobin (metHb)/ferricyanide reductase activity, plasma metHb, and proinflammatory cytokines in the chronic HD patients without treatment (n=15) or with vitamin C (VC)- (n=15), vitamin E (VE)-coated dialyzer (n=15), or ERW treatment (n=15) during an HD course. The patients showed marked increases (15-fold) in blood reactive oxygen species, mostly H(2)O(2), after HD without any treatment. HD resulted in decreased plasma VC, total antioxidant status, and erythrocyte metHb/ferricyanide reductase activity and increased erythrocyte levels of phosphatidylcholine hydroperoxide (PCOOH) and plasma metHb. Antioxidants treatment significantly palliated single HD course-induced oxidative stress, plasma and RBC PCOOH, and plasma metHb levels, and preserved erythrocyte metHb /ferricyanide reductase activity in an order VC>ERW>VE-coated dialyzer. However, ERW had no side effects of oxalate accumulation easily induced by VC. Six-month ERW treatment increased hematocrit and attenuated proinflammatory cytokines profile in the HD patients. In conclusion, ERW treatment administration is effective in palliating HD-evoked oxidative stress, as indicated by lipid peroxidation, hemolysis, and overexpression of proinflammatory cytokines in HD patients.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Antioxidants; Ascorbic Acid; Biomarkers; Cell Survival; Electrolysis; Erythrocytes; Female; Hematocrit; Hemodialysis Solutions; Humans; Kidney Failure, Chronic; Male; Membranes, Artificial; Methemoglobin; Middle Aged; Oxidative Stress; Reactive Oxygen Species; Renal Dialysis; Vitamin E; Water

Topics: Anemia; Ascorbic Acid; Erythropoietin; Female; Humans; Infusions, Intravenous; Male; Prospective Studies; Renal Dialysis

Ascorbate supplementation for patients on regular dialysis treatment (RDT) is advised to obviate deficiency and improve epoetin response in those with functional iron deficiency. However, clear-cut safety concerns regarding hyperoxalemia are still poorly understood. This study tries to establish safety/efficacy profiles of ascorbate and oxalate during long-term intravenous ascorbate supplementation.. A prospective study was performed in 30 patients on RDT showing ascorbate deficiency (plasma ascorbate < 2.6 mg/L [<15 micromol/L]): 18 patients were administered intravenous ascorbate during 18 months (250 mg/wk, subsequently increased to 500 mg), and 12 patients were taken as reference untreated cases. Plasma ascorbate and oxalate assays and dialytic balance determinations were performed (ion chromatography and reverse-phase high-performance liquid chromatography, respectively) at baseline, during treatment, and 12 months after withdrawal.. Plasma ascorbate levels increased dose dependently with supplementation (1.6 +/- 0.8 mg/L [9.1 +/- 4.6 mumol/L] at baseline, 2.8 +/- 1.8 mg/L [15.9 +/- 10.1 micromol/L]) with 250 mg of ascorbate, and 6.6 +/- 2.8 mg/L [37.5 +/- 16.0 micromol/L] with 500 mg/wk of ascorbate), but only normalized with greater dosages for several months in 94% of patients. Baseline plasma oxalate levels increased from 3.2 +/- 0.8 mg/L (35.8 +/- 8.8 micromol/L) to 3.6 +/- 0.8 mg/L (39.5 +/- 9.1 micromol/L) and 4.5 +/- 0.9 mg/L (50.3 +/- 10.4 micromol/L) with 250 and 500 mg, respectively ( P < 0.001). The calcium oxalate saturation threshold was exceeded by 7 of 18 patients (40%) during 6 months therapy with 500 mg/wk. Ascorbate dialysis removal increased from 37.8 +/- 23.2 mg (215 +/- 132 micromol) to 99.6 +/- 51.7 mg (566 +/- 294 micromol) during supplementation (P < 0.001), with corresponding increases in oxalate removal from 82.5 +/- 33.2 mg (917 +/- 369 micromol) to 111.2 +/- 32.6 mg/L (1,236 +/- 362 micromol; P < 0.01). Withdrawal reverted plasma levels and dialysis removal to initial values. Values for untreated patients did not change during 1 year of follow-up.. Patients on RDT may resolve ascorbate deficiency with intravenous supplementation of 500 mg/wk, but this implies a significant risk for oxalate supersaturation. Oxalate measurements are strongly recommended during long-term ascorbate therapy.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Ascorbic Acid; Ascorbic Acid Deficiency; Calcium Oxalate; Drug Resistance; Erythropoietin; Female; Humans; Hyperoxaluria; Infusions, Intravenous; Kidney Failure, Chronic; Male; Middle Aged; Prospective Studies; Renal Dialysis

Intravenous (i.v.) ascorbic acid (AA) improves anaemia in iron-overloaded, erythropoietin (rEPO) hyporesponsive haemodialysis patients. While oral AA is readily attainable, the efficacy and safety of oral versus i.v. AA has not been examined.. We conducted an open-label randomised parallel study on the effects of 8 weeks of 250 mg oral AA (n=10) compared with 250 mg i.v. AA (n=11) 3x/week on haemoglobin (Hb), ferritin and rEPO dose in 21 iron-overloaded haemodialysis patients. We also examined the effect of 3 months of 500 mg oral AA 3x/week (n=70) compared with no treatment (n=83) on Hb, ferritin and rEPO dose in 153 haemodialysis patients.. Patients had severe AA deficiency (mean 2.2+/-SE 0.4 mg/L; normal range, 4.0-14.0). Following treatment, the plasma AA level increased (P<0.001), but was not significantly different between the groups. There was no change in Hb, iron availability and rEPO dose with oral or i.v. AA. There was a significant increase in serum oxalate but no significant changes in left ventricular function or renal calculi formation. In the second study, oral AA had no effect on Hb, rEPO dose and ferritin in the whole group and a subgroup of 30 with anaemia.. Haemoglobin and iron availability did not improve following oral or i.v. AA in this select small group of iron-overloaded haemodialysis patients or in a larger population of haemodialysis patients given oral AA at a higher dose and for a longer duration. AA supplementation may still be warranted in view of severe AA deficiency in haemodialysis patients.

Topics: Administration, Oral; Adult; Aged; Anemia; Ascorbic Acid; Erythropoietin; Female; Humans; Injections, Intravenous; Male; Middle Aged; Recombinant Proteins; Renal Dialysis

Vitamin C has been reported to be an effective adjuvant agent in the treatment of anemia in iron-overloaded hemodialysis patients. We aim to evaluate its effect on erythropoietin (EPO) response in a prospective, randomized, double-blind, crossover study.. Sixty-three patients were randomly divided into two groups. Group 1 was treated with intravenous vitamin C, 500 mg, three times a week, and group 2, with placebo for 6 months. During the second 6-month period, group 1 was treated with placebo, and group 2, with the same dose of vitamin C. Thirty patients in group 1 and 28 patients in group 2 completed the study. Hemoglobin levels, weekly EPO dose, and ratio of EPO to hemoglobin as an index of EPO need were determined at both baseline and the end of the two periods, together with other parameters known to be associated with EPO response.. Twenty patients in group 1 (66.7%) and 18 patients in group 2 (64.3%) were responsive to vitamin C. In both groups, vitamin C resulted in a significant increase in hemoglobin levels (P < 0.0001 for both) and a significant decrease in EPO-hemoglobin ratio (P < 0.0001, P = 0.019). Transferrin saturation also increased with vitamin C treatment in both groups (P = 0.009, P = 0.005). All these parameters remained stable with placebo in both groups. Other parameters did not change throughout the study.. Vitamin C can be used as an effective adjuvant therapy to EPO in hemodialysis patients. Further studies are needed to determine possible predictors of hematologic response to vitamin C.

Topics: Adult; Anemia; Ascorbic Acid; Cross-Over Studies; Double-Blind Method; Drug Interactions; Erythropoietin; Female; Hemoglobins; Humans; Injections, Intravenous; Kidney Failure, Chronic; Male; Middle Aged; Prospective Studies; Renal Dialysis; Transferrin; Treatment Outcome

A study was done on school children infected with group A beta hemolytic streptococci to examine whether antioxidant vitamins play a role in improving the hemoglobin level. A total of 606 primary school children aged 5 to 15 years were randomly divided into two intervention groups. Group 1 (n=299) was treated with pehnoxymethyl penicillin V and group 2 (n=307) was treated with phenoxymethyl penicillin V plus antioxidant vitamins for eight weeks. From each group two blood samples were drawn in acute and convalescent (after eight weeks) states. Before treatment, mean hemoglobin values were 11.0 and 10.8 mg/dL in groups 1 and 2 respectively. After treatment hemoglobin values were 10.5 and 11.6 mg/dL respectively. Values were significantly decreased in group 1 (P=0.0001), whereas increased in group 2 (P=0.001). Adjustment for age and sex by ANCOVA confirmed the difference in hemoglobin levels between group (LS means-0.5 vs 0.8 in groups 1 and 2 respectively (P=0.0001). Hemoglobin level increases after antioxidant vitamin supplementation in children suffering from group A beta hemolytic streptococcal infection.

Topics: Adolescent; alpha-Tocopherol; Anemia; Antioxidants; Ascorbic Acid; beta Carotene; Child; Child, Preschool; Female; Hemoglobins; Humans; Male; Penicillins; Streptococcal Infections; Streptococcus pyogenes; Vitamins

To obtain baseline data on hemoglobin (Hb) levels of adolescent girls belonging to the low-socio-economic groups; investigate the comparative efficacy of once 'weekly' and 'daily' administration of iron-folate tablets with respect to impact on the Hb levels; and find out the effect of added ascorbic acid supplementation on the efficacy of iron-folate administration with respect to increment in Hb levels.. Randomized experimental.. Adolescent girls of poor communities in urban areas of Delhi and rural parts of Bharatpur (Rajasthan).. The baseline investigations included measurements of height, weight, and Hb levels. The Hb levels of the participating subjects were measured again after 3 months and 6 months of supplementation.. 61.9% of the subjects in the urban and 85.4% in the rural area were anemic. The response of Hb levels to daily iron/folate supplementation was better in comparison to once-weekly supplementation. The increment in Hb levels of subjects due to addition of vitamin C to iron/folate supplementation was more than that with supplementation of iron/folate alone.. Considering compliance, feasibility and cost-factors, a public-health approach consisting of once-weekly distribution of iron/folate supplementation through schools and welfare centers is better and can be recommended as an appropriate strategy for combating anemia in adolescent girls of poor communities in developing countries like India.

Topics: Adolescent; Analysis of Variance; Anemia; Ascorbic Acid; Child; Drug Combinations; Female; Folic Acid; Humans; India; Iron; Poverty Areas; Regression Analysis

Topics: Adolescent; Adult; Aged; Anemia; Ascorbic Acid; Cross-Over Studies; Humans; Injections, Intravenous; Iron Deficiencies; Middle Aged; Renal Dialysis

Impaired uteroplacental perfusion has been shown to play a role in the pathogenesis of some complicated pregnancies with placenta insufficiency. Apart from this, lower oestrogen, magnesium and zinc are found in many of these conditions in the third trimester with placenta insufficiency. In this study, we examined the effect of a 4 mg intravenous dexamethasone injection on estriol, since maternal cortisol or synthetic corticosteroids cross the placental barrier and inhibit the release of dehydroepiandrostesone sulfate in the fetal adrenals. Dexamathasone was found to suppress estriol levels in all groups but a significant difference in suppression was found between the Chemiron--a new combination hematinic--and the control single iron therapy groups. Our preliminary results showed that Chemiron has a protective effect on the development of placenta insufficiency during the third trimester of pregnancy.

Topics: Adult; Anemia; Ascorbic Acid; Dexamethasone; Drug Combinations; Estriol; Female; Ferrous Compounds; Folic Acid; Hematinics; Humans; Magnesium Sulfate; Placental Insufficiency; Pregnancy; Pregnancy Tests; Pregnancy Trimester, Third; Vitamin B 12; Zinc Sulfate

Functional iron deficiency may develop and cause erythropoietin resistance in haemodialysis patients with iron overload. Controversy remains as to whether intravenous iron medication can improve this hyporesponsiveness due to decreased iron availability, or whether iron therapy will aggravate haemosiderosis. Intravenous administration of ascorbic acid has been shown to effectively circumvent resistant anaemia associated with iron overload in a small preliminary study. To elucidate further the possible mechanisms of this resistance, a parallel, comparative study was conducted to compare the effects of intravenous iron and ascorbate therapies in iron-overloaded haemodialysis patients.. Fifty haemodialysis patients with serum ferritin of > 500 microg/l were randomly divided into two protocols. They were further stratified into controls (Control I, n = 11) and intravenous iron group (IVFE, n = 15) in protocol I; and into controls (Control II, n = 12) and intravenous ascorbic acid group (IVAA, n = 12) in protocol II. Controls had a haematocrit of > 30% and did not receive any adjuvant therapy. IVFE and IVAA patients were hyporesponsive to erythropoietin and functionally iron deficient. Ferric saccharate (100 mg dose) was administered intravenously postdialysis on five consecutive dialysis sessions in the first 2 weeks; and ascorbic acid (300 mg dose) thrice a week for 8 weeks. Red cell and iron metabolism indices were examined before and following therapy.. Mean values of haematocrit and transferrin saturation were significantly lower, and erythropoietin dose was higher in IVFE and IVAA patients compared to controls. Intravenous iron therapy neither improved erythropoiesis nor reduced erythropoietin dose during 12 weeks. Iron metabolism indices significantly increased at 2 and 6 weeks, but decreased at 12 weeks returning to the baselines. In contrast, mean haematocrit significantly increased from 25.8+/-0.5 to 30.6+/-0.6% with a concomitant reduction of 20% in erythropoietin dose after 8 weeks of ascorbate therapy. Serum ferritin modestly fell but with no statistical significance. The enhanced erythropoiesis paralleled a rise in transferrin saturation from 27+/-3 to 48+/-6% and serum iron from 70+/-11 to 107+/-19 microg/dl (P<0.05).. Short term intravenous iron therapy cannot resolve the issue of functional iron deficiency in haemodialysis patients with iron overload. Intravenous administration of ascorbic acid not only facilitates iron release from storage sites, but also increases iron utilization in the erythron. Our study draws attention to a potential adjuvant therapy, intravenous ascorbic acid, to treat erythropoietin-hyporesponsive anaemia in iron-overloaded patients.

Topics: Anemia; Ascorbic Acid; Erythropoietin; Female; Follow-Up Studies; Humans; Injections, Intravenous; Iron; Iron Overload; Male; Middle Aged; Oxalic Acid; Recombinant Proteins; Renal Dialysis

There is little evidence to support the general assumption that dietary carotenoids can improve vitamin A status. We investigated in Bogor District, West Java, Indonesia, the effect of an additional daily portion of dark-green leafy vegetables on vitamin A and iron status in women with low haemoglobin concentrations (< 130 g/L) who were breastfeeding a child of 3-17 months. Every day for 12 weeks one group (n = 57) received stir-fried vegetables, a second (n = 62) received a wafer enriched with beta-carotene, iron, vitamin C, and folic acid, and a third (n = 56) received a non-enriched wafer to control for additional energy intake. The vegetable supplement and the enriched wafer contained 3.5 mg beta-carotene, 5.2 mg and 4.8 mg iron, and 7.8 g and 4.4 g fat, respectively. Assignment to vegetable or wafer groups was by village. Wafers were distributed double-masked. In the enriched-wafer group there were increases in serum retinol (mean increase 0.32 [95% CI 0.23-0.40] mumol/L), breastmilk retinol (0.59 [0.35-0.84] mumol/L), and serum beta-carotene (0.73 [0.59-0.88] mumol/L). These changes differed significantly from those in the other two groups, in which the only significant changes were small increases in breastmilk retinol in the control-wafer group (0.16 [0.02-0.30] mumol/L) and in serum beta-carotene in the vegetable group (0.03 [0-0.06] mumol/L). Changes in iron status were similar in all three groups. An additional daily portion of dark-green leafy vegetables did not improve vitamin A status, whereas a similar amount of beta-carotene from a simpler matrix produced a strong improvement. These results suggest that the approach to combating vitamin A deficiency by increases in the consumption of provitamin A carotenoids from vegetables should be re-examined.

Topics: Anemia; Ascorbic Acid; beta Carotene; Breast Feeding; Carotenoids; Diet; Double-Blind Method; Energy Intake; Female; Folic Acid; Follow-Up Studies; Food, Fortified; Hemoglobins; Humans; Indonesia; Infant; Iron; Milk, Human; Nutritional Status; Vegetables; Vitamin A

Twenty-eight strict vegetarians were given 500 mg ascorbic acid twice daily after lunch and dinner for two months. Hemoglobin and certain iron status parameters were measured before and after the treatment. Ascorbate treatment increased mean hemoglobin by 8%, serum iron by 17% and transferrin saturation by 23% and decreased total iron binding capacity by 7%. All these changes were statistically significant. The rise in serum ferritin was 12%. The serum protein or copper level did not indicate their dietary deficiency, while initial serum ascorbate level were low which rose by 60% on therapy. It is concluded that ascorbate supplementation is a better method of improving hematologic and iron status than iron salt administration.

Topics: Adolescent; Adult; Anemia; Anemia, Iron-Deficiency; Ascorbic Acid; Diet, Vegetarian; Female; Ferritins; Hemoglobins; Humans; Iron; Male; Middle Aged

Fifty-four anaemic preschool children, all consuming similar, purely vegetarian, diets were randomly divided equally into an experimental and a control group. The children in the experimental group received 100 mg ascorbic acid twice a day, with lunch and with dinner, for 60 days. The controls received sugar placebos. Initially and at the end of the intervention, haemoglobin (Hb) and red cell morphology were estimated in all children. The children who received ascorbic acid supplements showed a significant improvement in Hb level as well as in red cell morphology, while the controls showed no change. Chemical analysis of the diets of a subsample showed ascorbic acid intakes to be very low.

Topics: Anemia; Ascorbic Acid; Child, Preschool; Diet, Vegetarian; Erythrocyte Indices; Female; Hemoglobins; Humans; Iron; Male

This study was conducted to examine the relationship between anemia, supplementation with iron and vitamin C, and productivity. Using the cyanmethemoglobin method, 671 female garment factory workers were examined. On the basis of the World Health Organization (WHO) standard, 98 were found to be mildly or moderately/severely anemic. An equal number was randomly chosen from the nonanemic workers. The subjects were then randomly assigned to either the placebo group or the group receiving 525 mg of ferrous sulfate (105 mg elemental iron) and 500 mg ascorbic acid. Only 118 of the 196 subjects completed the three-month study. The mean hemoglobin (Hb) and work output, as indicated by efficiency rating (ER), of the placebo group did not change significantly. Mildly anemic workers with supplements showed a significant improvement in mean Hb, but not in mean ER. The moderately/severely anemic group receiving supplements had significant increases in both Hb and ER.

Topics: Adolescent; Adult; Anemia; Ascorbic Acid; Efficiency; Employment; Female; Hemoglobins; Humans; Iron

Infants born to mothers who served an subjects of an iron supplementation study among pregnant women were followed-up for one year to assess the benefits derived by the infants from the iron treatment of the mothers. Hemoglobin and hematocrit levels at one to three months after birth were not statistically different between infants of iron-treated and untreated mothers. Infants aged six to twelve months who have not received any dietary iron supplement and were born from iron-treated mothers tended to have slightly higher hemoglobin levels than infants born to mothers not treated with iron during pregnancy but differences were not statistically significant. Mean hemoglobin levels for the infants aged six to twelve months who received daily iron supplement were significantly higher compared to hemoglobin levels of infants with either no iron or with intermittent iron supplement. Initial hemoglobin and hematocrit levels of pregnant mothers before supplementation and at one month postpartum, which were included in the report, showed higher gains in hemoglobin levels for the anemic mothers treated with iron compared to the gain found for the placebo group.

Topics: Anemia; Ascorbic Acid; Clinical Trials as Topic; Female; Hematocrit; Hemoglobins; Humans; Infant; Infant, Newborn; Iron; Placebos; Pregnancy; Pregnancy Complications, Hematologic

Topics: Adolescent; Anemia; Ascorbic Acid; Humans; Neoplasms; Scurvy; Thrombocytopenia

Scurvy is a deadly disease caused by a lack of vitamin C in the diet. Although frequently considered a disease from the past, it still occurs in modern-day society, including in developed countries.. We report a case of an 18-year-old male who was admitted with bleeding into his legs, prolonged prothrombin time and partial thromboplastin time, and anemia requiring a blood transfusion. His history included congenital deafness and a restrictive eating pattern primarily consisting of fast food. He was deficient in folic acid, vitamin K, and vitamin C. Scurvy best explained the bleeding, and he improved with vitamin supplementation.. Scurvy is a collagen production disorder that can cause bleeding on the skin and mucous membranes. Although rare in industrialized nations, scurvy is typically the result of a restrictive diet or malnutrition. Those who are at a particularly high risk are the elderly, alcohol abusers, and those with eating disorders.. Scurvy is easily treatable but can be missed; therefore, a high level of suspicion should be present in patients at risk for malnutrition. Those diagnosed with scurvy should be screened for concomitant nutritional deficiencies.

Topics: Adolescent; Aged; Anemia; Ascorbic Acid; Humans; Male; Scurvy; United States

Topics: Acute Kidney Injury; Anemia; Ascorbic Acid; Child; Glucosephosphate Dehydrogenase; Glucosephosphate Dehydrogenase Deficiency; Humans

A man in his 50s with dialysis-dependent end-stage renal disease, several weeks history of progressive skin bruising and acute-onset gastrointestinal bleeding presented to the emergency department following a syncopal event during routine haemodialysis owing to profound hypotension. He was found to have a severe normocytic, normochromic anaemia requiring several blood transfusions. He followed a diet lacking fruits and vegetables and stopped taking renal multivitamins. All parameters of coagulation were unremarkable, but serum vitamin C level was undetectable, supporting a diagnosis of scurvy. Although typically associated with individuals who are at risk of malnourishment, such as those with alcohol use disorder, malabsorption, and those who experience homelessness, scurvy should be considered in patients receiving renal replacement therapy as vitamin C is removed during haemodialysis.

Topics: Anemia; Ascorbic Acid; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Renal Dialysis; Scurvy; Vitamins

This study was conducted to explore the relationship between anemia and falls in postmenopausal women. The relationships between energy, protein, iron, and vitamin C intake were also checked. The data of this study are a combination of data from the Korea National Health and Nutrition Examination Survey (KNHANES) collected from the KNHANES VI-2,3 (2014-2015) and VII-1,2,3 (2016-2018). Falls and anemia were compared according to the subjects' characteristics. Phi and Cramer's V coefficient were applied to find the strength of association. Energy, protein, iron, and vitamin C intake and anemia were investigated. The relationship between the status as anemic and the occurrence of falls was analyzed using binary logistic regression. Of the 6665 subjects, 274 had a fall, and 596 had anemia. If the energy intake did not meet the estimated energy requirements, the state of anemia was significantly higher with a weak association. When protein, iron, and vitamin C did not meet the recommended nutrient intake, the anemia state was considerably higher with a weak to moderate association. Postmenopausal women with anemia were more likely to fall than subjects without anemia (OR = 1.88,

Topics: Anemia; Ascorbic Acid; Female; Humans; Iron; Nutrition Surveys; Postmenopause; Republic of Korea

Scurvy results from a deficiency of ascorbic acid. This disease first appeared in children during the 19th century with the emergence of new dietary habits; in particular, heating milk that leads to a loss of ascorbic acid. Even though scurvy has become a rare condition in western countries, many cases are still reported in pediatric patients, especially in those who lack proper nutrition due to neurological or psychiatric illnesses. Symptoms include bleeding and swollen gums, loosening of teeth, bone abnormalities, arthralgia, delayed wound healing, anemia, petechiae, and purpura. Bone lesions are mainly irregularities of long bones metaphyses. We report the case of a five-year-old boy who presented with arthralgia and limb deformation (genu valgum). The patient was investigated for vitamin deficiencies to exclude rickets. The radiologic investigations revealed metaphyseal signs compatible with scurvy. During the hospitalization, the patient was observed to have abnormal eating patterns and the scurvy was attributed to malnutrition. Although the occurrence of scurvy is rare, it remains essential to detect this disease in children at risk of developing vitamin deficiencies. Without targeted treatment, the complications of scurvy can be serious and potentially fatal.

Topics: Anemia; Arthralgia; Ascorbic Acid; Child; Child, Preschool; Humans; Male; Nutritional Status; Scurvy

Dear Editor, Scurvy is a nutritional disorder which can develop after prolonged (>1-3 months) severe vitamin C deficiency. Vitamin C is a cofactor in several enzyme reactions involved in collagen synthesis. The defect in collagen causes blood vessel fragility, poor wound healing, mucocutaneous bleedings, hair abnormalities, bone pains, and joint contractures due to periosteal and intraarticular bleeding (1,2). Risk factors for scurvy development are undernutrition, low socioeconomic status, older age, male sex, alcoholism, tobacco smoking, and severe psychiatric illnesses (1-3). The required daily intake for vitamin C is ~60 mg, and this amount of vitamin C can be found in only one medium-sized orange. For this reason, the disease is rarely encountered in developed countries and is often underrecognized by healthcare personnel. Herein, we present an illustrative case of scurvy in order to raise the awareness of this disorder. A 61-year-old Caucasian man was admitted to hospital due to fatigue, hypotension (80/50 mmHg), severe normocytic anemia (hemoglobin 76 g/L), kidney failure (estimated glomerular filtration rate of 6 mL/min/1.73m2) and mild elevation in C-reactive protein (30.9 mg/L). Prior medical history included radical cystoprostatectomy with an ileal conduit performed eight years ago due to a bladder tumor and moderate chronic kidney disease with recurrent urinary tract infections. The patient was also an alcoholic and tobacco smoker, with a very low-income and a poor diet. He did not use any medications. Heteroanamnestically, the current clinical state had developed slowly over several weeks. At admission, the patient was afebrile, lethargic, malnourished, and immobile due to generalized weakness, bone pains, and hip and knee contractures. He had generalized edema, mostly related to kidney failure, as well as severe hypoalbuminemia (serum albumin 19 g/L). There were multiple ecchymoses (Figure 1, a) and perifollicular bleedings (Figure 1, b) in the skin. The teeth were defective, and the patient's facial hair had a "corkscrew" appearance (Figure 1, c). The platelet count was normal, as was the serum fibrinogen level and the prothrombin- and activated partial thromboplastin times. Vancomycin-resistant Enterococcus faecium and multi-drug-resistant Acinetobacter baumanii were isolated from the urine. Therefore, hemodialysis, linezolid, and colistin were started. However, the patient continued to be lethargic, immobile, and with prominent skin bleed

Topics: Anemia; Anticoagulants; Ascorbic Acid; Ascorbic Acid Deficiency; C-Reactive Protein; Colistin; Contracture; Fatigue; Fibrinogen; Humans; Linezolid; Male; Middle Aged; Prothrombin; Renal Insufficiency; Scurvy; Serum Albumin; Thromboplastin; Vancomycin; Vitamins

Topics: Aged; Anemia; Ascorbic Acid; Avitaminosis; Cognition Disorders; Contusions; Diagnosis, Differential; Diet; Dizziness; Hemoglobins; Humans; Male; Melena; Scurvy

Since ancient times, scurvy has been considered one of the most fearsome nutritional deficiency diseases. In modern developed countries, this condition has become very rare and is only occasionally encountered, especially in the pediatric population. Underlying medical conditions, such as neuropsychiatric disorders, anorexia nervosa, celiac disease, Crohn disease, hemodialysis, and severe allergies to food products may enhance the risk of developing scurvy.. We report the case of an otherwise healthy 3-year-old white boy who developed scurvy due to a selective restrictive diet derived from his refusal to try new food. He presented to our clinic with asthenia and refusal to walk. During hospitalization he developed severe anemia and hematochezia. A diagnosis of scurvy was assessed on the basis of nutritional history, clinical features, radiographic findings, and laboratory findings. Supplementation of ascorbic acid enabled a prompt resolution of symptoms.. Scurvy is caused by vitamin C deficiency. Cutaneous bleeding, mucosal bleeding, and anemia represent typical manifestations of the disease. These symptoms are directly connected to ascorbic acid involvement in collagen biosynthesis. Some radiographic findings can be useful for the diagnosis. Treatment aims to normalize serum levels of vitamin C in order to counteract the deprivation symptoms. The present case report demonstrates that scurvy may sporadically occur in pediatric patients, even in individuals with no predisposing medical conditions and/or potential risk factors.

Topics: Anemia; Ascorbic Acid; Asthenia; Child Nutritional Physiological Phenomena; Child, Preschool; Diet; Gastrointestinal Hemorrhage; Humans; Male; Nutritional Status; Risk Factors; Scurvy; Vitamins

We report a case of a man in his 60s who developed pulmonary arterial hypertension (PAH) in association with profound vitamin C deficiency. Decreased availability of endothelial nitric oxide and activation of the hypoxia-inducible family of transcription factors, both consequences of vitamin C deficiency, are believed to be mechanisms contributing to the pathogenesis of the pulmonary hypertension. The PAH resolved following vitamin C supplementation. The current case highlights the importance of testing for vitamin C deficiency in patients with PAH in the proper clinical setting.

Topics: Aged; Anemia; Arthralgia; Ascorbic Acid; Ascorbic Acid Deficiency; Cardiac Catheterization; Echocardiography; Endothelium, Vascular; Exanthema; Humans; Hypoxia; Male; Nitric Oxide; Pulmonary Arterial Hypertension; Transcription Factors; Vitamins

A 66-year-old Caucasian woman was admitted with deteriorating mental health in the setting of background history of schizophrenia and depression. Her husband reported that she had increasing negative thoughts and decreased motivation regarding her self-care over a few weeks with no obvious stressors. Initial laboratory tests were unremarkable except for isolated normocytic anaemia. Physical examination revealed widespread bilateral upper limb ecchymoses and lower limb petechial rash. After an extensive investigation with no definitive results to explain her clinical presentations, diagnosis of scurvy was suspected and confirmed with severely low serum vitamin C level. Her clinical symptoms improved markedly with oral supplementation, which further supported the diagnosis of scurvy. Although it is now a rare condition in developed countries, this case will remind modern medical practitioners that patients with scurvy may present with non-specific symptoms and clinical findings such as depression and anaemia.

Topics: Aged; Anemia; Ascorbic Acid; Depression; Female; Humans; Scurvy

While scurvy is considered to be a rare disease in the modern era, the disease still presents in certain populations with nutritional deficiencies such as those with poor nutritional absorption secondary to gastrointestinal disorders and in patients with poor nutritional intake. We present a case of scurvy in a patient who had eosinophilic oesophagitis which limited his oral intake. He presented with the classic symptoms of scurvy including a perifollicular rash, arthralgia, gingivitis and anaemia. He was treated with intravenous vitamin C initially followed by an oral course after which he showed improvement. This case demonstrates that it is important to consider vitamin C deficiency in patients with who present with anaemia and bleeding stigmata specifically in those who have poor nutritional intake. Furthermore, additional consideration should be given to patients with malnutrition as part of the preoperative evaluation.

Topics: Administration, Intravenous; Anemia; Ascorbic Acid; Biopsy; Diagnosis, Differential; Eosinophilic Esophagitis; Humans; Iron; Physical Examination; Scurvy; Severity of Illness Index; Skin; Treatment Outcome; Vitamins

Anemia prevalence in India remains high despite preventive iron supplementation programs. Consequently, concurrent national policies of iron fortification of staple foods have been initiated.. This study evaluated the relation between dietary iron intake and anemia (hemoglobin <12 g/dL) in women of reproductive age (WRA; 15-49 y) with respect to iron fortification in India.. Data from 2 national surveys were used. Data on hemoglobin in WRA were sourced from the National Family Health Survey-4, whereas dietary intakes were sourced from the National Sample Survey. Adjusted odds for anemia with increasing iron intake were estimated, along with the effect of modulating nutrients such as vitamins B-12 and C, from statistically matched household data from the 2 surveys. The risks of inadequate (less than the Estimated Average Requirement for WRA) and excess (more than the tolerable upper limit for WRA) intakes of iron were estimated by the probability approach.. The relation between iron intake and the odds of anemia was weak (OR: 0.992; 95% CI: 0.991, 0.994); increasing iron intake by 10 mg/d reduced the odds of anemia by 8%. Phytate and vitamin B-12 and C intakes modified this relation by reducing the odds by 1.5% when vitamin B-12 and C intakes were set at 2 μg/d and 40 mg/d, respectively. The additional intake of 10 mg/d of fortified iron reduced the risk of dietary iron inadequacy from 24-94% to 9-39% across states, with no risk of excess iron intake. Approximately doubling this additional iron intake reduced the risk of inadequacy to 2-12%, but the risk of excess intake reached 22%.. Providing fortified iron alone may not result in substantial anemia reduction among WRA in India and could have variable benefits and risks across states. Geographically nuanced dietary strategies that include limited fortification and the intake of other beneficial nutrients should be carefully considered.

Topics: Adolescent; Adult; Anemia; Anemia, Iron-Deficiency; Ascorbic Acid; Diet; Energy Intake; Female; Food, Fortified; Health Surveys; Hemoglobins; Humans; India; Iron; Iron Overload; Iron, Dietary; Middle Aged; Phytic Acid; Risk Factors; Vitamin B 12; Young Adult

Scurvy is a nutritional disease caused by ascorbic acid deficiency and is potentially fatal. It was originally described in the 18th century by James Lind and associated with long sea voyages and insufficient citrus consumption. Its prevalence has declined markedly over the years but has still been described sporadically in certain countries. A 22-year-old woman with an anxiety disorder and anorexia nervosa, recent pregnancy and ongoing breast feeding, presented with a 10-day history of spontaneous haematomas in the lower limbs, gingivorrhagia and fatigue. The examination was remarkable for signs of minor bleeding without haemodynamic compromise, gonalgia and pale skin. Work-up studies revealed the presence of anaemia. Direct anamnesis identified a diet based solely of tea and carbohydrates due to distorted body image. With the working diagnosis of scurvy, nutritional support and oral vitamin C supplementation was initiated. Her symptoms and anaemia resolved in 30 days and the diagnosis was confirmed biochemically.

Topics: Adult; Anemia; Anorexia Nervosa; Anxiety Disorders; Ascorbic Acid; Breast Feeding; Diagnosis, Differential; Diet; Dietary Carbohydrates; Dietary Supplements; Fatigue; Female; Gingival Hemorrhage; Hematoma; Humans; Scurvy; Tea; Young Adult

Topics: Anemia; Antioxidants; Ascorbic Acid; Ascorbic Acid Deficiency; Diet, Healthy; Humans; Male; Middle Aged; Scurvy

Topics: Abdominal Pain; Anemia; Antioxidants; Ascorbic Acid; Child, Preschool; Cough; Cytochrome-B(5) Reductase; Diagnosis, Differential; Emergency Service, Hospital; Glucosephosphate Dehydrogenase Deficiency; Headache; Humans; Hypoxia; Intensive Care Units; Jaundice; Male; Methemoglobinemia; Methylene Blue; Morocco; Oxygen Inhalation Therapy; United States; Vicia faba

In Switzerland, vitamin C deficiency is a rare condition. Nonetheless, in clinical practice, there are some patients exhibiting a vitamin C deficiency as a result of an unbalanced diet or intestinal malabsorption. We report the clinical history of a 55-year-old man known for alcoholism and insufficient intake of fresh fruits and vegetables. He was admitted to the intensive care unit, for haemodynamic instability caused by blood loss due to fragile vessels (skin, gastrointestinal). Further analyses revealed a severe lack of vitamin C. The patient received a high dose of intravenous substitutive treatment, leading to a favourable clinical outcome.

Topics: Alcoholism; Anemia; Ascorbic Acid; Ascorbic Acid Deficiency; Diet; Hemodynamics; Humans; Male; Malnutrition; Middle Aged; Purpura; Switzerland

Topics: Acrylamides; Administration, Oral; Anemia; Ascorbic Acid; Caco-2 Cells; Cell Survival; Drug Carriers; Drug Delivery Systems; Ferric Compounds; Ferritins; Heme; Hemin; Humans; Hydrogen-Ion Concentration; Iron; Micelles; Microscopy, Confocal; Molecular Weight; Particle Size; Polyethylene Glycols; Polymers; Sulfates; Temperature; Ultraviolet Rays

To assess anaemia and oxidative stress in rats that were injected lead and to evaluate the possible effects of ascorbic acid supplementation on these parameters.. This randomised control trial study was conducted at the Army Medical College, Rawalpindi, Pakistan, from October 2007 to September 2008, and comprised Sprague Dawley rats. The rats were randomly divided into three groups. The rats in Group 1 were given weekly injections of sodium acetate, and rats of Group 2 and 3 were given weekly injections of lead acetate. Ascorbic acid was supplemented in the drinking water of rats of Group 3. At the end of six weeks, terminal sampling was done and blood obtained was used to assess the serum malondialdehyde levels and red cell parameters.. Of the 105 rats, each group had 35(33.33%). The overall mean age was 105±15 days and the mean weight was 225±25gm. The mean malondialdehyde level was 3.2±0.39 µmol /L in Group 1, 7.8±0.48 in Group 2 and 3.8±0.34 in Group 3 (p<0.001). The mean haemoglobin level was 13.16±0.57 g/dL, 10.64±0.86 and 12.22±0.81, respectively (p<0.001). The red blood cells count was 7.63±0.33 106/µL in Group 1, 6.29±0.54 in Group 2 and 6.83±0.45 in Group 3 (p<0.001).. Administration of ascorbic acid in drinking water significantly reduced the oxidative stress and anaemia caused by lead intoxication.

Topics: Anemia; Animals; Ascorbic Acid; Dietary Supplements; Lead Poisoning; Oxidative Stress; Pakistan; Random Allocation; Rats; Rats, Sprague-Dawley; Vitamins

Anaemia among children is a public health issue in Ghana. The Ghana School Feeding Programme (GSFP) was instituted on pilot basis in an effort to provide nutritious lunch to school children. Evidence on the nutritional status of pupils is needed to inform the expansion of GSFP. This study sought to assess anaemia among Ghanaian pupils.. This cross-sectional study involved a random sample of 143 pupils aged 6 to 12 years. Blood samples were collected and analysed for serum-ferritin (SF), C-reactive protein (CRP), haemoglobin and malaria-parasitaemia (MP). Stool samples were examined for soil-transmitted helminths. Dietary data were collected using the 24 hour-recall method on three non-consecutive days and a food frequency questionnaire. The Student's t-test was used to compare mean values between sexes. Binary logistic regression was performed to identify factors associated with anaemia. Statistical significance was set at p < 0.05.. SF and haemoglobin concentrations were 23.9 ± 15 ng/ml and 120 ± 11 g/L respectively. The prevalence of anaemia was 30.8%. More females (41.5%) than males (21.8%) had anaemia (p < 0.005). Seventy-one percent of pupils had low SF levels. MP prevalence was 67.8%. Hookworm infestation was only observed in males (18.0%). Dietary iron and vitamin C intakes were 18.98 ± 8.8 mg and 23.7 ± 6.7 mg, respectively. Child's sex, SF and MP were associated with anaemia. Males had a lower likelihood of being anaemic (OR = 0.2, CI 0.1-0.5, p = 0.002).. The study findings underscore the need for multi-pronged approaches that address both malaria control and nutrition in order to reduce anaemia among pupils.

Topics: Anemia; Ascorbic Acid; C-Reactive Protein; Child; Cross-Sectional Studies; Female; Ferritins; Ghana; Hemoglobins; Hookworm Infections; Humans; Iron, Dietary; Logistic Models; Malaria; Male; Nutritional Status; Prevalence; Sex Factors

Topics: Anemia; Ascorbic Acid; Colonic Diseases; Deglutition Disorders; Ecchymosis; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Middle Aged; Rectum; Scurvy; Stomach Diseases

The association between the intake of iron, vitamins A and C and calcium and the prevalence of anemia and hemoglobin (Hb) levels was investigated in adolescents.. A cross-sectional study was developed with 529 Brazilian students. Anemia was defined in terms of Hb concentration. Nutrient intake was assessed by a 3-day food record. The association between the prevalence of inadequate nutrient intake and anemia was estimated by the χ(2) test, and that between nutrient intake and Hb by linear regression.. The prevalence of inadequate nutrient intake did not differ between nonanemic and anemic subjects. Anemic adolescents had a lower mean intake of iron than nonanemic adolescents. Among boys aged 11-13 years, the anemic subjects had lower vitamin C intake than those who were nonanemic (41.1 vs. 62.6 mg, p < 0.01), and among those aged 14-19 years, there was a tendency for a positive association between Hb and heme iron intake (β = 0.64, p = 0.06) and a negative association with calcium intake (β = -0.003, p = 0.02). In females, daily nutrient intake did not differ between anemic and nonanemic individuals.. Heme iron and vitamin C are possible protective factors against anemia in boys. However, the lack of association between inadequate iron intake and anemia, especially in girls, suggests that other factors beyond diet could explain anemia in this age range.

Topics: Adolescent; Anemia; Ascorbic Acid; Brazil; Calcium, Dietary; Child; Cross-Sectional Studies; Diet Records; Energy Intake; Feeding Behavior; Female; Hemoglobins; Humans; Iron, Dietary; Linear Models; Male; Nutritional Status; Prevalence; Vitamin A; Young Adult

The aim of this study was to investigate the effects of vitamin C on cisplatin (DDP)-induced anemia and explore its possible mechanisms in rats. Adult male Sprague-Dawley rats were randomly divided into six groups: control, vitamin C 50, vitamin C 100, DDP, DDP plus vitamin C 50 and DDP plus vitamin C 100-treated groups. DDP was intravenous injected as a single dose and vitamin C was administered by gavage. Serum erythropoietin (Epo), hemoglobin (Hb) and blood urea nitrogen (BUN) concentration were measured 4 and 14 days after DDP treatment. The changes of renal tissue were examined by light microscope. Administration of DDP to rats induced anemia and nephrotoxicity, characterized with a significant decrease in serum Epo and Hb and increase in BUN concentrations. Pathological examination revealed that DDP caused significant renal damage in rats. Vitamin C administration produced amelioration in biochemical indices of anemia and nephrotoxicity and in histological change when compared to group DDP alone; concurrent administration of vitamin C at doses of 100 mg/kg being more effective. Results from this study indicate that the novel natural antioxidant vitamin C might have protective effect against DDP-induced anemia in rats.

Topics: Anemia; Animals; Antineoplastic Agents; Antioxidants; Ascorbic Acid; Cisplatin; Dose-Response Relationship, Drug; Kidney; Male; Rats; Rats, Sprague-Dawley

Scurvy is a disease that results from a vitamin C deficient diet. Since vitamin C is available in many food products, and especially in citrus fruits, the disease is rare in developed countries. Clinical manifestations of scurvy include general weakness, cutaneous and gum bleeding, pain in the lower limbs and inability to stand and walk (pseudo paralysis). The diagnosis of scurvy requires a high level of clinical suspicion, typical radiographic features and low Levels of vitamin C in the plasma. We report a case of a 7-year-old patient with a medical history of hydrocephalus, failure to thrive and severe psychomotor retardation due to complications of prematurity. On admission she had gum bleeding, severe anemia, pain in the lower limbs and refused to stand and walk. According to her parents, her diet was restricted, without vegetables or fruit consumption. Our investigation ruled out coagulopathy, malignancy and infection. Serum vitamin C levels were low and radiographic findings were consistent with the diagnosis of scurvy. The patient improved rapidly after the initiation of vitamin C supplements. Despite being rare, scurvy should be considered in the differential diagnosis of bleeding and pain in the lower limbs, especially in a malnourished patient.

Topics: Anemia; Ascorbic Acid; Blood Transfusion; Child; Child Nutrition Disorders; Citrus; Developmental Disabilities; Enteral Nutrition; Failure to Thrive; Feeding Behavior; Female; Gingival Hemorrhage; Humans; Infusions, Intravenous; Mobility Limitation; Musculoskeletal Pain; Phytotherapy; Radiography; Scurvy; Treatment Outcome

The present study investigates the potential ability of selenium, considered as an antioxidant with pharmacological property to alleviate oxidative stress and hematological parameter disorders induced by methimazole, an antithyroid drug. Pregnant Wistar rats were randomly divided into four groups of six each: group I served as negative control and received a standard diet; group II received 250 mg/L of methimazole in drinking water and a standard diet; group III received both methimazole (250 mg/L, orally) and selenium (0.5 mg/kg of diet) supplemented to the standard diet; group IV served as positive control and received a supplement of selenium in the diet (0.5 mg/kg of diet) as sodium selenite (Na(2)SeO(3)). Treatment was started from the 14th day of pregnancy until day 14 after delivery. Methimazole reduced the number of red blood cells, hemoglobin concentration and hematocrit in mothers and their pups. Besides, plasma iron, vitamins B(9), B(12), C and E levels were reduced. Lipid peroxidation increased, objectified by high malondialdehyde levels and lactate dehydrogenase activity in plasma, while glutathione, glutathione peroxidase, superoxide dismutase and catalase activities showed a significant decline. Co-administration of selenium through diet improved all the parameters cited above. It can be concluded that the administration of selenium alleviates methimazole-induced toxicity, thus demonstrating its antioxidant efficacy.

Topics: Anemia; Animals; Animals, Newborn; Animals, Suckling; Antioxidants; Antithyroid Agents; Ascorbic Acid; Disease Models, Animal; Female; Folic Acid; Glutathione; Hematologic Tests; Iron; Lipid Peroxidation; Male; Malondialdehyde; Methimazole; Oxidative Stress; Oxidoreductases; Pregnancy; Pregnancy Complications, Hematologic; Protective Agents; Rats; Rats, Wistar; Selenium; Vitamin B 12; Vitamin E

The effects of aqueous extract of Hibiscus sabdariffa calyces on haematology and pathological changes in some selected organs during experimental Trypanosoma congolense infection of rats were investigated. Three groups of rats were intraperitoneally infected with T. congolense (Karu stock). One group was administered with the aqueous extract and another given a solution of vitamin C in drinking water; the remaining infected group was left untreated. Data from these groups were compared with those of two groups of healthy rats, one of which was similarly treated with the aqueous extract. The experiment was terminated three weeks, post-infection (pi). The uninfected and infected rats administered the extract consumed the equivalent of 9.94 mg - and 9.61 mg ascorbic acid / 100g / day during the experiment. Consumption of the extract significantly (p<0.01) retarded the rate of weight gain in both healthy and infected rats; even though the feed-intake was not significantly affected. After two weeks of infection the extract and vitamin C kept the parasitaemia significantly (p<0.01) lower than the untreated infected group. The anaemia in the untreated infected group was significantly (p<0.01) more severe than that of the corresponding extract- or vitamin-treated groups. Trypanosoma congolense infection caused significant (p<0.01) decreases in serum total proteins and albumin; serum and organ ascorbic acid as well as significant (p<0.01) elevation of serum alanine amino transferase levels in untreated rats. Consumption of the extract or vitamin C, however, prevented these disease-induced anomalies in the treated infected rats. Serum creatinine and urea levels were not affected by infection but the extract elevated these parameters significantly (p<0.01) above infection levels. It was concluded that consumption of the extract ameliorated the pathological changes in blood and organs of T. congolense-infected rats.

Topics: Anemia; Animals; Ascorbic Acid; Creatinine; Hematocrit; Hibiscus; Injections, Intraperitoneal; Kidney; Liver; Male; Parasitemia; Plant Extracts; Rats; Rats, Wistar; Trypanosoma congolense; Trypanosomiasis, African; Water

To determine the efficacy and effects of the oral administration of ascorbic acid on anemia management in ESRD patients with hyperferritinemia.. Twenty-one anemic hemodialysis patients with ferritin levels greater than 350 ng/mL had received oral daily ascorbic acid at a dose of 500 mg/day and were retrospectively studied. Hemoglobin, hematocrit, EPO dose, ferritin, and transferrin saturation were recorded at baseline and after three months of treatment. EPO dose/hematocrit was calculated. Serum oxalate levels were also measured.. Hb increased 9% from 11.4 to 12.2 gm/dL (p = 0.05), HCT increased 10% from 33.3 to 36.7% (p = 0.05), but EPO dose requirement decreased 33% from 26,229 to 17,559 U/week (p = 0.03). Ferritin levels decreased 21% from 873 to 691 ng/mL (p = 0.004). Mean oxalate level during therapy was 87 micromol/L (normal <27). Patients with oxalate levels >27 micromol/L were instructed to stop ascorbic acid treatment, and mean levels decreased from 107 to 19 micromol/L (p = 0.01) over a mean time of 71 days.. In this study, daily oral ascorbic therapy decreased ferritin levels and EPO dose requirements while raising hemoglobin and hematocrit level. This beneficial profile of effects of ascorbic acid therapy is consistent with improvement of EPO resistance and cost savings in this population.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anemia; Ascorbic Acid; Cohort Studies; Drug Administration Schedule; Female; Ferritins; Humans; Iron Metabolism Disorders; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Retrospective Studies; Treatment Outcome; Vitamins

Topics: Anemia; Ascorbic Acid; Calcium Oxalate; Dose-Response Relationship, Drug; Drug Administration Routes; Humans; Hyperoxaluria; Iron Compounds; Renal Dialysis; Treatment Outcome; Uremia; Vitamins

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired stem-cell disorder associated with intravascular hemolysis and thrombosis. Hemolysis is caused by the hypersensitivity of PNH-red blood cells (RBC) to complement-mediated lysis due to deficiency in the surface glycosyl phosphatidylinositol-anchored antigens, CD55 and CD59. Thrombosis may be related to the platelet tendency to undergo hyperactivation. We previously suggested that hemolysis and thrombosis in other hemolytic anemias are related to oxidative stress. In the present study, we assessed the oxidative status of blood cells in PNH and tested the potential protective effects of antioxidants.. Blood samples were obtained from 11 PNH patients and 11 normal control donors. Flow cytometry was used to measure oxidative stress markers in conjunction with the PNH immunophenotype.. Results indicated that abnormal, CD55/CD59-negative, RBC, neutrophils, and platelets are under oxidative stress. Their intracellular reactive oxygen species, membrane lipid peroxides, and external phosphatidylserine were higher and their reduced glutathione was lower than CD55/CD59-positive cells of the same patient or cells of normal controls. PNH-RBC were hypersensitive to an oxidative insult (e.g., hydrogen peroxide) and their oxidative status increased following interaction with complement, prior to hemolysis. Antioxidants reduced this hemolysis as well as activation of PNH platelets.. We propose that oxidative stress mediates the symptoms of PNH and suggest that antioxidants might be considered as a therapeutic modality.

Topics: Acetylcysteine; Anemia; Antioxidants; Ascorbic Acid; Biomarkers; Blood Platelets; Erythrocytes; Female; Flow Cytometry; Hemoglobinuria, Paroxysmal; Humans; Hydrogen Peroxide; Male; Neutrophils; Oxidants; Oxidative Stress; Reference Values; Thrombosis; Tocopherols

Uptake and recycling of ascorbic acid (AA) were studied in erythrocytes of 1- to 12-month-old Beagle dogs. At 1 month, both AA uptake and recycling capacity were high. Ascorbic acid entered erythrocytes mainly in the oxidized form with elevated activity of Glut 1 glucose transporter. However, this trait of erythrocytes was rapidly lost in the course of postnatal growth. At 3 months, ascorbic acid uptake and recycling capacity decreased to almost adult levels. Thereafter, AA was transported mainly in the reduced form, and its uptake and recycling capacity became one-third the levels of 1-month-old dogs. Postnatal anemia and recovery were indicated by changes in hemoglobin and packed cell volume levels at 1 and 3 months. Glutathione reductase (GR) activity was twice as high as in adults in 1-month-old dogs, allowing efficient reduction of oxidized ascorbic acid, which enters cells in large amounts due to elevated activity of the Glut 1 glucose transporter. One-month-old dogs need high levels of AA for antioxidant protection and skeletal development. The high AA recycling capacity of erythrocytes is considered to balance the expenditure of AA in young Beagle dogs.

Topics: Age Factors; Aging; Anemia; Animals; Ascorbic Acid; Biological Transport; Deoxyglucose; Dogs; Erythrocytes; Female; Glucose Transporter Type 1; Glutathione; Glutathione Reductase; Hematocrit; Hemoglobins; Male; Oxidation-Reduction

Topics: Anemia; Ascorbic Acid; Diagnosis, Differential; Duodenal Ulcer; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Scurvy; Treatment Outcome

Topics: Anemia; Ascorbic Acid; Chemotherapy, Adjuvant; Clinical Trials as Topic; Drug Therapy, Combination; Erythropoietin; Humans; Kidney Failure, Chronic

Topics: Adult; Androgens; Anemia; Ascorbic Acid; Blood Cell Count; Blood Transfusion; Carnitine; Contraindications; Erythropoietin; Female; Ferritins; Hemoglobins; Humans; Iron; Male; Recombinant Proteins; Renal Dialysis; Renal Insufficiency, Chronic; Vitamins

Topics: Adolescent; Androgens; Anemia; Ascorbic Acid; Blood Cell Count; Blood Transfusion; Carnitine; Child; Child, Preschool; Contraindications; Erythropoietin; Ferritins; Hemoglobins; Humans; Infant; Infant, Newborn; Iron; Recombinant Proteins; Renal Dialysis; Renal Insufficiency, Chronic; Vitamins

A 53-year-old woman, known with a schizophrenic disorder and a history of drug addiction, was referred because of progressive hematomas of the lower extremities and fatigue. Her medical history included hyperplastic gums, tooth hypermobility and anaemia. Scurvy was diagnosed as a result of an insufficient diet due to drug addiction and a paranoid psychosis. After suppletion of vitamin C and starting highly nutritious food a rapid amelioration of the scurvy related complaints was observed. While dreaded and often fatal in earlier eras, in the 21st century scurvy is easily treatable if this diagnosis is recognised.

Topics: Anemia; Antioxidants; Ascorbic Acid; Female; Humans; Middle Aged; Schizophrenia; Scurvy; Substance-Related Disorders; Tooth Mobility; Treatment Outcome

This investigation aims to explore the association among anemia and vitamins A, C, and folate deficiencies in a probabilistic sample of Mexican children.. Data on hemoglobin, serum vitamins A and C and folate concentrations and percent transferrin saturation (PTS) in children 0.5-11 years (n = 1,770) were extracted from the database of the probabilistic Mexican National Nutrition Survey 1999 (NNS-99).. Overall, 16.6% of children were anemic. Iron deficiency children with or without anemia had more frequent low serum retinol (40.6 vs. 16% and 27.7 vs. 11.9%, p < 0.05, respectively) and lower hemoglobin folate (11.5 vs. 22%, p < 0.05) than their non-iron deficiency counterparts. Mean concentrations of serum iron (p < 0.01), folate (p < 0.001) and retinol (p < 0.0001), but not ascorbic acid (p < 0.6), were significantly lower in anemic than in nonanemic children. In a linear regression model, 15% of hemoglobin variation in children was explained by retinol, folate and PTS, but not vitamin C (p <0.0001).. Anemia was mostly associated with iron deficiency and with a lesser proportion of folate and vitamin A deficiencies. Vitamin A deficiency might be overestimated since iron deficiency may lower serum retinol concentrations. Interventions aimed to reduce anemia in this population must consider interactions between those micronutrients in designing strategies.

Topics: Adolescent; Adult; Anemia; Ascorbic Acid; Ascorbic Acid Deficiency; C-Reactive Protein; Child; Child, Preschool; Comorbidity; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Hemoglobins; Humans; Infant; Iron; Iron Deficiencies; Male; Mexico; Micronutrients; Middle Aged; Prevalence; Sampling Studies; Transferrin; Vitamin A; Vitamin A Deficiency

Topics: Anemia; Antioxidants; Ascorbic Acid; Drug Therapy, Combination; Ferric Compounds; Ferric Oxide, Saccharated; Glucaric Acid; Humans; Injections, Intravenous; Kidney Failure, Chronic; Renal Dialysis

Scurvy is a nondiscriminatory disease process resulting from a nutritional deficiency of ascorbic acid (vitamin C). The severe vitamin deficiency produces a breakdown in the cellular structure of the body. This case report describes a middle-age woman with a history of edema, bruising of the lower extremities, anemia, and severe periodontal disease. Her presentation and medical history are classic for the signs of scurvy. Scurvy is now only uncommonly seen in developed countries, but there are still vulnerable populations whose nutritional status can lead to scurvy. The aim of this report is to help the clinician identify and treat scurvy, a disease that was once feared for its high mortality but is now easily treatable, even in cases that have progressed to multiple organ dysfunction and failure.

Topics: Adult; Anemia; Ascorbic Acid; Female; Gingivoplasty; Halitosis; Humans; Periodontal Diseases; Purpura; Scurvy; Tooth Extraction; Vitamins

Iron-deficiency or anemia in pregnancy is a major public health problem in China. This cross-sectional study was carried out to observe the association between iron status and multiple vitamin levels of Chinese pregnant women in the third trimester. We measured iron, ascorbic acid, retinol, folate and vitamin B12 in serum, and riboflavin in urine specimens of 1,163 pregnant women in four sites throughout rural and city areas in China. Based on hemoglobin concentrations (Hb), the subjects were divided into an anemia group with Hb < 110 g/L or Hb < or = 100 g/L as severe anemia group, and nonanemia group with Hb > or = 110 g/L. Results showed that 41.58% of the population with serum iron < 700 microg/L and 51.04% of the population with ferritin < 12 microg/L in the anemia group, percentages that were much higher than those in the nonanemia group. Relationships between five vitamins and hemoglobin concentrations of all subjects were observed. There was a lower level of serum ascorbic acid (291.05 microg/dL) in the Hb < or = 100 g/L group than in the Hb > or = 120 g/L group (487.79 microg/dL) (p < 0.001). Serum levels of vitamin B12 and folate were 445.67 pg/mL and 5.94 ng/mL in the Hb < or = 100 g/L group, whose levels were much lower than the levels of 502.01 pg/mL (p < 0.012) and 8.07 ng/mL (p < 0.010) respectively in the Hb > or = 120 g/L group. Further, cross-sectional analysis showed positive correlations between abnormal hematological results and prevalences of vitamin deficiencies. The subjects with iron-deficiency anemia had much higher rates of vitamin C, folate and vitamin B12 deficiencies than those in the nonanemic subjects, and especially in the deficient rates of ascorbic acid and folate in the anemia (Hb < 110 g/L) group, which reached 64.04% and 22.70% respectively. Moreover, we observed that the decreasing trends of hemoglobin concentrations were accompanied by the decreases of serum levels of vitamin A, ascorbic acid, folate and vitamin B12. In conclusion, multiple vitamin deficiencies, especially ascorbic acid, retinol and folic acid, may be associated with anemia or iron deficiency in pregnant women in the last trimester. The study suggested that anemic pregnant women in China should be supplemented with iron and multiple vitamins simultaneously.

Topics: Adult; Anemia; Ascorbic Acid; China; Female; Folic Acid; Hemoglobins; Humans; Iron; Iron Deficiencies; Nutritional Status; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Trimester, Third; Riboflavin; Vitamin A; Vitamin B 12; Vitamins

The redox unbalance in erythrocytes has been found to contribute significantly in the development of anemia in visceral leishmaniasis (VL). The present study revealed enhanced production of reactive oxygen species (ROS) and gradual depletion of alpha-tocopherol and ascorbate in the erythrocytes of infected animals. The response of erythrocytes to chronic treatment with antioxidants was studied in hamsters during leishmanial infection. Treatment with a combination of alpha-tocopherol and ascorbate proved to be the most effective preventive for the proteolytic degradation of erythrocyte membrane. Erythrocytes from infected animals were thermally more sensitive compared to the control ones. Combination of both antioxidants was most successful in resisting heat induced structural defects in the cells. Cross-linking of membrane proteins subsequent to oxidative damage in the red cells was accompanied by the formation of high molecular weight protein band at the top of the resolving gel in the presence of the cross-linking agent dimethyladepimidate (DMA). Marked inhibition of cross-linking was observed with combination of both antioxidants. Treatment with alpha-tocopherol and ascorbate together could withstand osmotic lysis of erythrocytes in the infected animals very efficiently. Decreased hemoglobin (Hb) level was successfully replenished and was coupled with significant increase in the life span of red cells after treating the animals with both antioxidants. Results indicate better efficacy of the combination therapy with alpha-tocopherol and ascorbate in protecting the erythrocytes from structural and functional damages during leishmanial infection.

Topics: alpha-Tocopherol; Anemia; Animals; Antioxidants; Ascorbic Acid; Cricetinae; Cross-Linking Reagents; Drug Combinations; Erythrocytes; Hemoglobins; Leishmania donovani; Leishmaniasis, Visceral; Mesocricetus; Osmotic Fragility; Reactive Oxygen Species

Intravenous vitamin C supplementation to haemodialysis patients might ameliorate responsiveness to recombinant human erythropoietin (rHuEpo). This study was performed to analyse the relation between vitamin C plasma concentration and response to rHuEpo.. In a cross-sectional, single-centre observational study including all haemodialysis patients, pre-dialysis plasma vitamin C concentrations were measured by high-performance liquid chromatography and response to rHuEpo (haemoglobin concentration/international units rHuEpo/kg/week) was recorded together with baseline laboratory data.. Univariate analysis yielded a significant correlation between vitamin C plasma levels and response to rHuEpo (n = 130, r = 0.25, P = 0.004), which still persisted after adjustment for transferrin saturation, C-reactive protein, malondialdehyde, parathyroid hormone, route of rHuEpo administration, residual renal function and diabetes mellitus (adjusted r = 0.23, P = 0.014). Analysis per quartiles of vitamin C plasma level revealed a significantly lower response to rHuEpo with decreasing vitamin C values (P = 0.026).. In unselected haemodialysis patients, vitamin C plasma levels account, at least partially, for the response to rHuEpo. Larger-sized interventional studies are needed to find out whether vitamin C plasma levels may or may not appropriately reflect the potential beneficial effect of vitamin C supplements on rHuEpo responsiveness.

Topics: Aged; Anemia; Ascorbic Acid; Cross-Sectional Studies; Erythropoietin; Female; Hematinics; Humans; Kidney Failure, Chronic; Male; Middle Aged; Recombinant Proteins; Renal Dialysis

The analysis of vitamin and iron indexes of 95 children sufficiently supplied with vitamin C and vitamin B2 and carotenoids deficiency has been carried out. Vitamin E deficit takes place among anemic children (with decreased hemoglobin blood level) 2 fold more often than among healthy children. From another side, decreased hemoglobin blood level, erythrocyte quantity and erythrocyte indexes have been determined 1.7-2.4 fold more often in insufficiently supplied with vitamin E children. Tocopherols serum level had tendency to the decrease and vitamin E deficit took place 2 fold more frequently in children suffering from iron deficiency anemia that is with decreased hemoglobin and serum ferritin concentrations. Marked positive linear correlation between these iron indexes and vitamin E serum level has been revealed. These results give evidence concerning significant role of this vitamin in the body iron supplying. The results obtained give evidence for multi-deficient anemia presence among children, which are not always caused by iron deficit. High frequency of vitamin E and B group vitamins deficiency proves expediency of these vitamins inclusion in complex therapy of iron deficiency.

Topics: Adolescent; Anemia; Anemia, Iron-Deficiency; Ascorbic Acid; Carotenoids; Child; Erythrocyte Count; Hemoglobins; Humans; Iron; Iron Deficiencies; Riboflavin; Tocopherols; Vitamin E Deficiency

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.

Topics: Adolescent; Adult; Aged; Anemia; Ascorbic Acid; Blood Proteins; Child; Female; Humans; Male; Middle Aged; Nutrition Disorders; Vitamin E; Wound Healing

Recent report demonstrates that inadequate iron mobilization and defective iron utilization may cause recombinant erythropoieitin (rEPO) hyporesponsiveness in hemodialysis (HD) patients with iron overload. The effect of intravenous ascorbic acid (IVAA) in HD patients selected on the basis of iron overload and EPO resistance also has been proven. However, it is uncertain whether IVAA still works in diabetic ESRD patients with hyperferritinemia. Therefore, the aim of this study focusing on diabetic ESRD patients was to analyze the potential effect of low dose IVAA on improvement of anemia and erythropoiesis-related parameters when compared with control period.. This study consisted of 22 chronic hemodialysis patients with type II diabetes in a single dialysis unit. In studies of this type, all eligible patients are followed up, but the primary comparison is still between different sequentially treatment including control period and post-IVAA period in same patients. IVAA patients received ascorbic acid, 100 mg each administered intravenously three times per week for eight weeks of treatment and four months of post-treatment follow-up.. The demographic characteristics of 22 diabetic uremic patients show that mean age is 63.6 +/- 10.2 years old. The ratio of sex (M/F) = 10/12. Mean duration of HD is 46.7 +/- 33.2 months. As for the urea kinetic study between these two periods including KT/V, nPCR, and URR, there is no significantly different. As for anemia-related parameters, Hb and Hct increased significantly in post-IVAA period after 3 months compared with control period, while MCV did not increase significantly. Serum ferritin significantly decreased at study completion. The same situation is for iron. As for TS, it significantly increased at one month and further markedly increased at subsequent three months.. This study has demonstrated that short-term low dose IVAA therapy can facilitate iron release from reticuloendothelial system but also increase iron utilization in diabetic hemodialysis patients with iron overload. Therefore, IVAA is a potential adjuvant therapy to treat erythropoeitin-hyporesponsive anemia in iron-overloaded patients.

Topics: Aged; Anemia; Ascorbic Acid; Biomarkers; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Dose-Response Relationship, Drug; Erythrocyte Indices; Erythropoietin; Female; Ferritins; Follow-Up Studies; Free Radical Scavengers; Hematocrit; Hemoglobins; Humans; Infusions, Intravenous; Iron; Iron Overload; Kidney Failure, Chronic; Male; Middle Aged; Parathyroid Hormone; Phosphates; Prospective Studies; Recombinant Proteins; Renal Dialysis; Serum Albumin; Taiwan; Time Factors; Treatment Outcome

Formative research was conducted with 26 women and 16 adolescent girls to develop an education intervention through community kitchens (CK) in Lima, to increase their dietary iron intake and improve their iron status. A combination of qualitative research methods was used to explore perceptions about foods, nutrition, health, anemia and body image. The women recognized that there was a close association among eating well, "alimentarse bien", their health and prevention and treatment of anemia. They perceived that the nutritive value of a meal is determined primarily by its content of "nutritious" foods and by its being "balanced". Using this information the conceptual model of the education intervention was developed. The vulnerability of women to anemia was presented with the relationship between anemia and diet as the central focus. Feasible ways of achieving a nutritious diet were introduced to the community kitchens through promoting local heme iron sources and the consumption of beans with a vitamin C source. Animal source foods were amongst those considered to be nutritious and were "best buys" for iron content. CK searched for ways of assuring accessibility to these foods. The use of animal source foods in the community kitchen menus increased during the intervention.

Topics: Adolescent; Adult; Anemia; Ascorbic Acid; Community Health Services; Developing Countries; Diet; Dietary Proteins; Female; Health Education; Health Knowledge, Attitudes, Practice; Humans; Interviews as Topic; Iron; Peru

One tablet of Sorbifer Durules contains 100 mg Fe2+ and 60 mg vitamin C. The authors examined in a short-term study 24 haemodialyzed patients with chronic renal failure of different etiology. The investigation was divided into three parts. During the first 4 weeks the patients did not receive Fe2+ nor vitamin C. During the subsequent four weeks the patients had Sorbifer Durules, one tablet/24 hours. This period was followed by another four weeks when the patients went again without Fe2+ and vitamin C treatment. At regular intervals, i.e. on days 0, 28, 56 and 84 the authors assessed the packed cell volume, blood haemoglobin and serum iron level, the total iron binding capacity, transferrin saturation, ferritin, and vitamin C in serum as well as the plasma oxalic acid level. Four weeks treatment using Sorbifer Durules led to a significant rise of the packed cell volume and haemoglobin in blood, iron and vitamin C in serum. This treatment did not affect the oxalic acid plasma level. Oral treatment with Sorbifer Durules, one tablet/24 hours, was adequate for maintaining the serum iron concentration in haemodialyzed patients during treatment with recombinant human erythropoietin. This treatment prevented at the same time the development of vitamin C deficiency in serum and a further rise of plasma oxalic acid in these patients.

Topics: Administration, Oral; Anemia; Ascorbic Acid; Drug Combinations; Female; Ferrous Compounds; Humans; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Tablets

The refining of silver from old silver ornaments, articles and jeweller's waste by smelting these with lead scraps for the fabrication of new jewellery is an important small scale industry in India. The present survey and clinical investigations have shown that 31 out of 50 silver refiners with a mean blood lead level of 32.84+/-1.78 microg/dl (range 20.3-64.9), decrease in blood delta-aminolevulinic acid dehydratase (ALAD) activity and thiamine (as pyruvate) level and an enhanced urinary excretion of ALA as compared to control, were suffering from lead poisoning. Most of these workers have shown anaemia, abdominal colic, blue lining of gum and muscular wasting indicative of lead toxicity. Twenty-four workers with relatively high blood lead levels were equally divided into two groups and given either vitamin B1 (75 mg, once a day) or vitamin C (250 mg. twice a day) for 1 month. The treatment with both the vitamins significantly lowered the blood lead levels and reduced blood thiamine and copper deficiency. In addition, vitamin C was also effective in reversing the inhibition of blood ALAD activity while the effect of vitamin B1 on its activity was marginal. The daily intake of vitamin B1 and vitamin C may prevent the accumulation of lead and reduce its toxic effects particularly in those regularly exposed to lead.

Topics: Adolescent; Adult; Anemia; Ascorbic Acid; Atrophy; Colic; Health Surveys; Humans; India; Lead Poisoning; Male; Metallurgy; Middle Aged; Muscle, Skeletal; Porphobilinogen Synthase; Preventive Medicine; Silver; Thiamine

To determine the effects of supplementing biscuits fortified with calcium (Ca) and vitamin D (VD), iron (Fe), vitamin C (VC) and zinc (Zn) to pregnant women from the 5th month of gestation until delivery on their health, and to explore a way to improve their Ca, Fe and Zn nutritional status during pregnancy.. A total of 313 healthy and primary pregnant women were enrolled and divided into five study groups based on their order visiting the hospitals for prenatal care. Each woman of the study groups was given three pieces of biscuit fortified with VD, Ca and VD, Ca, Zn and VD (Ca + Zn + VD), Ca, Fe, VC and VD (Ca + Fe + VD), Ca, Fe, VC, Zn and VD (Ca + Fe + Zn + VD), respectively, from the 15th month of gestation until delivery (24 weeks in total) daily. The fortified levels were 10 micrograms VD, 400 mg Ca from carbonate calcium, 10 mg Zn from lactate zinc, 10 mg Fe from ferrous lactate, and 50 mg VC, respectively. A parturient women was selected from the same hospital as control after one trial subject for each study groups selected.. The daily dietary intakes of Ca, Zn and Fe in pregnant women were only 47.7%, 54.7% and 86.7% of the Recommended Dietary Allowances for Chinese. Incidence of anemia for mid-term pregnant women was 35.2%, and Fe-supplementation could significantly improved their hemoglobin level (P < 0.05). Prevalence of anemia in the groups of Ca + Fe + Zn + VD and Ca + Fe + VD was 35.3% and 40.7%, respectively, before Fe supplementation and reduced to zero and 4.0%, respectively, after Fe supplementation. Whereas, prevalence of anemia in the other groups without Fe supplementation still kept in a relatively high level. In the groups supplemented with Ca, their plasma Ca level increased, especially with the best results in Ca + VD group. Plasma level of Zn declined with length of gestation, which could be improved by Zn supplementation. Serum level of alkaline phosphatase activity increased a little bit with length of gestation. There was no significant difference in radial and ulnar bone mineral density (BMD) between trial groups and controls two months after delivery. Maternal radial and ulnar BMD correlated significantly with their dietary Ca intakes in Ca + VD group.. The best way to improve maternal nutritional status is supplementation of Ca + Fe + Zn + VitD, based on the Recommended Dietary Allowances for Chinese.

Topics: Adult; Anemia; Ascorbic Acid; Calcium; Dietary Supplements; Female; Humans; Iron; Nutrition Policy; Nutritional Status; Pregnancy; Vitamin D; Women's Health; Zinc

Visceral leishmaniasis (V.L.) is associated with enhanced lipid peroxidation along with impaired function of antioxidant defense system in erythrocytes. The effect of chronic treatment with ascorbate and alpha-tocopherol was studied on erythrocytes in hamsters infected with Leishmania donovani. Combination treatment with both antioxidants proved to be a potential suppressor of lipid hydroperoxide formation as well as hypotonic osmotic lysis during the leishmanial infection. Positive correlations between the depleted levels of erythrocyte ascorbate, GSH and alpha-tocopherol exhibit proportionate alterations in the nonenzymatic antioxidant levels at different stages of infection. Indirect measurement of transmembrane electron transfer as ferricyanide reduction suggests an active participation of endogenous contents of ascorbate and alpha-tocopherol in the protection against oxidative damage of membrane lipids. Cooperative behavior of both antioxidants in the ferricyanide reducing capacity was further evinced by resealing the ghosts in presence of exogenous ascorbate and alpha-tocopherol. Furthermore, intravesicular ascorbate serves in the defense of extravesicular ferricyanide induced oxidation of endogenous alpha-tocopherol. The results suggest an interacting role of ascorbate and alpha-tocopherol in maintaining the antioxidant reserve of erythrocytes during anemia in V.L.

Topics: Anemia; Animals; Antioxidants; Ascorbic Acid; Cricetinae; Drug Interactions; Erythrocytes; Leishmania donovani; Leishmaniasis, Visceral; Lipid Peroxidation; Mesocricetus; Oxidation-Reduction; Vitamin E

I.v. ascorbic acid has been used in an effort to mobilize ferritin stores in hyporesponsive HD patients receiving Epoetin alfa. However, not all patients who respond to i.v. ascorbic acid therapy will have subsequent decline in feritin stores (Gastaldello et al., 1995; Tarng & Huang, 1998). Additionally, predicting those patients who will overcome their Epoetin alfa hyporesponsiveness remains unclear. Ascorbic acid's effect on hemosiderin deposits may be another possible mechanism to the increased Epoetin alfa response observed in some HD patients (Hemosiderin is a pathologic deposition of iron in tissues including the spleen, small intestine, and bone marrow). Although there are no well-controlled studies evaluating hemosiderin and i.v. ascorbic acid, it should be noted that subjects with scurvy often present with excessive iron deposits in the tissues, indicating the possible effects of ascorbic acid on hemosiderin metabolism (Bothwell et al., 1964). Ascorbic acid deficiency is often present in many HD patients due to its removal during dialysis and lack of dietary intake (Ponka & Kuhlback, 1983). It remains controversial whether oral ascorbic acid supplementation is indicated in patients receiving HD. Therefore, the Recommended Daily Allowance (RDA) of 60 mg/day should be advised (Makoff, 1999). I.v. ascorbic acid should be considered as a possible adjuvant to therapy in patients who are "iron-overloaded" and hyporesponsive to Epoetin alfa. Although the long-term effects of i.v. ascorbic acid on HD patients is unknown, the potential risk of secondary oxalosis should be considered (Costello, 1991; Pru, Eaton, & Kjellstrand, 1985). It may be necessary to monitor plasma oxalate levels if long-term therapy with i.v. ascorbic acid is used. Clinical studies have examined i.v. ascorbic acid doses from 300 mg-500 mg given up to TIW for a maximum duration of 12 weeks without any significant deleterious effects (Gastaldello et al., 1995; Tarng & Huang, 1998; Tarng et al., 1999). However, large-scale, prospective, and controlled trails are needed to determine the long-term safety and efficacy of i.v. ascorbic acid therapy in iron overloaded HD patients receiving Epoetin alfa.

Topics: Anemia; Antioxidants; Ascorbic Acid; Drug Therapy, Combination; Epoetin Alfa; Erythropoietin; Hematinics; Humans; Kidney Failure, Chronic; Recombinant Proteins

Topics: Anemia; Ascorbic Acid; Gastrectomy; Humans; Iron; Postoperative Care

Rabbits infected with Trypanosoma brucei brucei (Basa isolate) were intraperitoneally administered with vitamins C and E at 100 mg/kg and 10 mg/kg body weight, respectively, from day 7 before infection to day 12 post-infection (p.i.). Another group of rabbits were similarly infected, but received no vitamin treatment. The uninfected (control) rabbits were either untreated or treated with vitamins like the infected group. Treatment of the infected animals did not affect the onset and level of parasitaemia. On day 12 p.i., the anaemia tended to be ameliorated, but insignificantly, by the treatment. The infection increased (p<0.05) serum urea and creatinine concentrations to similar levels in treated and untreated groups. However, the increase (p<0.05) in alanine and aspartate transaminases in the untreated infected animals was prevented in the treated infected ones. Therefore, it seemed that the treatment with antioxidant vitamins boosted their storage in hepatic cells, but not in erythrocytes and glomeruli, to annul any cellular injury due to infection. It is concluded that this may be an indirect evidence that the hepatic damage may be principally due to oxidative injury.

Topics: Alanine Transaminase; Anemia; Animals; Ascorbic Acid; Aspartate Aminotransferases; Creatine; Hematocrit; Injections, Intraperitoneal; Kidney; Liver; Male; Parasitemia; Rabbits; Trypanosoma brucei brucei; Trypanosomiasis, African; Urea; Vitamin E

We studied Fe absorption from FeSO4 in rats with Fe deficiency-induced anaemia that were given an Fe-sufficient purified diet without or with ascorbic acid (10.4 g/kg diet). Attention was focused on mucosal Fe uptake as measured in vivo by a double-isotope technique. Haemoglobin repletion and liver Fe levels were not affected when the ascorbic acid-supplemented diet was given, but apparent Fe absorption and retention of orally administered 59Fe were significantly enhanced. The distribution of Fe between liquid and solid phases of contents of both the stomach and the proximal intestine was not affected by the feeding of the ascorbic acid, but ascorbic acid significantly enhanced mucosal Fe uptake. It is concluded that ascorbic acid in the diet raises mucosal Fe uptake through a mechanism independent of the intestinal Fe solubility.

Topics: Anemia; Animals; Ascorbic Acid; Intestinal Absorption; Intestinal Mucosa; Iron, Dietary; Male; Rats; Rats, Wistar; Solubility

Restrictive erythropoiesis caused by iron deficiency may hinder pre-deposit autotransfusion in surgical procedures. In order to evaluate the response to prophylactic ferrous ascorbate, a prospective study was conducted on patients subjected to orthopaedic surgery and autotransfusion.. Sixty-eight patients were included in the study: hip prostheses 67%, knee prostheses 25%, other procedures 7.4%. Their mean age was 61.3 +/- 10.2 years, and there were 42% male and 57% female. A mean of 2.8 +/- 0.6 units (450 mL) of blood were drawn to each patient in a month. Starting one week before their first blood donation and up to 2 months after surgery, each patient received 99 mg elementary iron per days as oral ferrous ascorbate. Blood cell counts were done at the beginning of the programme and after the first, second, third and fourth blood withdrawal, as well as one month after finishing the treatment. A survey of iron profile including serum iron, total iron binding capacity, transferrin saturation, serum ferritin and free erythrocyte protoporphyrin was carried out at onset and end of the programme in each patient. All data were analysed with the SPSS-PC 4.0 statistical programme.. Haemoglobin rates decreased in every control, returning to values close to the initial ones by the end of the programme (mean figures are as follows: 14.63; 13.17; 12.70; 11.88; 14.11 g/dL); and similar changes were seen with respect to the other parameters of blood. The initial and final values for ferritin were 157.32 and 91.06 ng/mL, respectively, and no significant changes were appreciated in the other data from the iron profile, regardless of the number of blood units collected in a given case. Minor intolerance to ferrous ascorbate appeared in 11% of the patients. No significant differences with control patients were seen regarding hospitalization (16.54 vs 19.82 days) or postoperative fever (14.1% vs 17.11%).. As opposed to others, we feel that iron treatment should be maintained up to 2 months after surgery since better results are thus attained. Recombinant erythropoietin is more expensive a method. Ferrous ascorbate is better tolerated than ferrous sulphate plus additives.

Topics: Anemia; Ascorbic Acid; Blood Transfusion, Autologous; Erythrocyte Count; Female; Ferritins; Hematocrit; Hip Prosthesis; Humans; Iron; Knee Prosthesis; Male; Preoperative Care; Prospective Studies; Transferrin

Twenty male triathletes (R 18-39 mean = 27.5 yrs) provided blood and faecal samples during intense training, pre-race taper and post-competition. All answered a closed-end questionnaire on intake of aspirin, NSAIDS, Vitamin C, iron and red meat. History of GIT blood loss and training distances were also obtained. Blood samples were taken on three occasions and analysed for Haemoglobin(Hb) and Serum Ferritin concentrations. Faecal specimens were collected on five occasions and assessed for blood loss using Haemoccult II and Monohaem (a monoclonal antibody test specific for human haemoglobin). Mean Hb and 95% confidence intervals at the three stages were 14.53gm/l (13.95-15.10), 14.9gm/l (14.46-15.34), 14.57gm/l (14.18-14.97) respectively. There was a small, but statistically significant, increase in Hb during the pre-race taper period (paired t = 2.65, p < 0.05), and a non-significant drop in Hb post-event (paired t = 1.89, p = 0.075). Mean ferritin, MCV and haematocrit values did not significantly change. Eighty percent of the group exhibited faecal blood loss on one or more of the tests used. There were significant increases in both Haemoccult (chi 2 = 5.44, p < 0.04) and Monohaem (chi 2 = 7.36 p < 0.02). Regression analysis demonstrated a significant relationship between training Hb and total training intensity (R = -0.61, F1,l5 = 8.98, p < 0.009) and training run intensity (R = -0.55, F1,l5 = 6.17, p < 0.026), as estimated using Coopers aerobic points system. These results confirm that GIT blood loss is common in endurance athletes, and appears to be related to exercise intensity. The possible mechanisms of blood loss are discussed.

Topics: Adult; Anemia; Anti-Inflammatory Agents, Non-Steroidal; Ascorbic Acid; Aspirin; Bicycling; Erythrocyte Indices; Feces; Ferritins; Gastrointestinal Hemorrhage; Hematocrit; Hemoglobins; Humans; Iron; Male; Meat; Physical Endurance; Running; Sports; Swimming

We report the case of a 82-year-old man, living in institution, hospitalized for a severe anaemia due to scurvy. Scurvy is rare in Occident. A multifactorial anaemia is usually associated with scurvy, but is rarely symptomatic. Alcoholism favours scurvy and anaemia. Treatment consisted of parenteral vitamin C supplementation associated with blood transfusion.

Topics: Aged; Aged, 80 and over; Alcoholism; Anemia; Ascorbic Acid; Ascorbic Acid Deficiency; Blood Transfusion; Hematoma; Humans; Male

Effects of iron supplementation on growth and hematological status of Indonesian anemic preschool children with low weight-for-age were investigated. A treatment group (n = 39) received daily supplements of 30 mg Fe and 20 mg vitamin C, whereas a control group (n = 37) received 20 mg vitamin C only for a period of 2 mo. Supplement allocation was double blind. At the start and finish of the study, body weight, height, food intake, and hemoglobin and serum ferritin concentrations were determined. Only the treatment group showed a significant increase in all hematological values (P < 0.001). Height and weight of all children increased (P < 0.01). Increases in height and height-for-age Z score in the treatment group were larger (P = 0.001) than the increase in the control group. The positive effect of iron supplementation on linear growth was not caused by increased food intake, but seems to be influenced by decreased morbidity. Iron supplementation may be a relatively inexpensive way to help decrease the high prevalence of stunting.

Topics: Aging; Anemia; Ascorbic Acid; Body Height; Body Weight; Child Development; Child, Preschool; Energy Intake; Humans; Iron

Chronic exposure of adult rats to dietary intake of cadmium (15 mg CdCl2/day/kg for 30 days) leads to development of anemia and thrombocytosis. Anemia is characterized by significant reticulocytosis (13.1 +/- 1.0%), anysocytosis, poikilocytosis, iron deficiency and marked alterations of antioxidant and metabolic status of red blood cells. Activities of SOD, catalase, GPx and GR were significantly increased in red blood cells of cadmium-treated rats. In treated animals cadmium induced an increase of red cell reduced and oxidized glutathione with no changes of GSSG/GSH ratio. However, significant reduction of lipid peroxidation was found. Plasma levels of tocopherol and ascorbate, as well as activity of glutathione-S-transferase, were all significantly increased in cadmium-treated rats. The energy metabolism of red blood cells was deeply altered in cadmium-treated rats. The levels of ATP, ADP, AMP and TAN were significantly increased while ATP/ADP ratio and adenylate energy charge (AEC) were significantly reduced. The level of 2,3-BPG was somewhat lower, but 2,3-BPG/Hb ratio was considerably higher, in red blood cells of cadmium-treated rats.

Topics: Adenine Nucleotides; Anemia; Animals; Antioxidants; Ascorbic Acid; Cadmium; Catalase; Energy Metabolism; Erythrocytes; Glutathione; Glutathione Peroxidase; Glutathione Transferase; Lipid Peroxidation; Oxidation-Reduction; Rats; Rats, Wistar; Superoxide Dismutase; Thiobarbituric Acid Reactive Substances; Thrombocytosis; Vitamin E

Two horses with red maple (Acer rubrum) toxicity responded to treatment with high doses of vitamin C (ascorbic acid), in addition to blood transfusions, and intravenous fluid therapy. The clinical course included Heinz body anemia, marked methemoglobinemia, depression, and evidence of severe tissue anoxia. Clinical recovery was dramatic with stabilization achieved 36 hours following the initiation of ascorbic acid therapy.

Topics: Anemia; Animals; Ascorbic Acid; Heinz Bodies; Horse Diseases; Horses; Hypoxia; Male; Methemoglobinemia; Plant Poisoning; Trees

Scurvy was diagnosed in 19 rhesus monkeys (Macaca mulatta) and four squirrel monkeys (Saimiri sciureus) from a colony of nonhuman primates maintained on a commercial diet. Signs of weakness, reluctance to move, gingival hemorrhage, bruising, proximal and distal metaphyseal fractures, weight loss and anemia appeared in juvenile and young adult rhesus monkeys over a 2 week period. Clinical signs subsided after 5 days of vitamin C therapy. At the same time, cephalohematomas and weakness developed in squirrel monkeys, which failed to respond to treatment. These cases were associated with manufacturer's admitted error in preparation of the commercially prepared monkey diet.

Topics: Anemia; Animal Feed; Animal Nutritional Physiological Phenomena; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Female; Macaca mulatta; Male; Monkey Diseases; Radiography; Saimiri

The effect of supplementing a regular diet with riboflavin or a combination of riboflavin and ascorbic acid on haematological indices was studied in 27 young Nigerian adults. Vitamin supplementation produced a significant increase (p less than 0.001) in haemoglobin concentration, haematocrit level and erythrocyte count. Both males and females responded similarly to the supplementation. The effect of riboflavin was similar to the combined effect of riboflavin and ascorbic acid. A significant association suggestive of enhanced erythropoiesis existed between Hb concentration and erythrocyte count in vitamin-supplemented subjects (r = 0.9722, p less than 0.002). The withdrawal of vitamin(s) supplements significantly diminished Hb concentration, haematocrit level and erythrocyte count to values similar to placebo. The data further showed that, even in malarial infection, Hb concentration, Hct level and erythrocyte count were maintained if high vitamin status was established through supplementation.

Topics: Administration, Oral; Adult; Anemia; Ascorbic Acid; Diet; Erythrocyte Count; Female; Food, Fortified; Hematocrit; Hemoglobins; Humans; Male; Nigeria; Riboflavin

Topics: Anemia; Animals; Ascorbic Acid; Biological Availability; Glycine max; Iron; Meat; Rats; Rats, Inbred Strains

The effects of elevated dietary ascorbic acid and iron on copper utilization were examined. Male Sprague-Dawley rats were fed one of two levels of Cu (deficient, 0.42 microgram Cu/g, or adequate, 5.74 micrograms Cu/g), Fe (moderate, 38 micrograms Fe/g or high, 191 micrograms Fe/g), and ascorbic acid (low, 0% or high, 1% of the diet) for 20 d. High Fe decreased (p less than 0.05) Cu absorption only in Cu-deficient rats. High ascorbic acid significantly decreased tissue Cu levels in Cu-adequate rats. High Fe with ascorbic acid caused severe anemia in Cu-deficient rats and decreased plasma ceruloplasmin by 44% in Cu-adequate rats. Cu,Zn-superoxide dismutase activity in erythrocytes was decreased (p less than 0.05) by 14% during Cu deficiency but was not affected by Fe or ascorbic acid. These results may be important to individuals with high intakes of Fe and ascorbic acid.

Topics: Absorption; Anemia; Animals; Ascorbic Acid; Ceruloplasmin; Copper; Diet; Feces; Hematocrit; Iron; Male; Rats; Rats, Inbred Strains; Superoxide Dismutase; Tissue Distribution

The effect of dietary iron on the development of copper-deficiency anemia in the growing rat was investigated. For up to 80 d, female rats (75 g) were fed purified diets containing adequate, marginal or low levels of iron, and either 0.7 or 10 ppm copper. Hemoglobin levels and factors postulated to affect liver iron mobilization, including ferroxidase (Fox) I and II, ascorbate and liver xanthine dehydrogenase (XDH) were assayed. By d 7, Fox I activity in the copper-deficient groups was 10% that of the copper-sufficient groups; thereafter, Fox I activity remained low, and was not affected by dietary iron. Fox II activity in the copper-deficient groups after d 28 was 50-75% of values from rats adequate in copper. On d 49, hemoglobin levels in the copper-deficient groups were lower than in the copper-sufficient groups fed low and marginal levels of iron, but were similar to those fed adequate iron. Liver iron was similar in both groups fed adequate iron, but was higher in the copper-deficient than in the copper-sufficient rats fed low or marginal levels of iron. Copper deficiency tended to result in slightly lower ascorbate levels on d 80 at all levels of iron. Liver XDH activity tended to be lower in the copper-deficient groups than in the copper-sufficient groups on d 28 and 49. These results show that copper deficiency may impair liver iron mobilization in the growing rat if dietary iron is low. Possible mechanisms include decreased Fox activity and/or decreased iron reduction by ascorbate or XDH.

Topics: Anemia; Animal Nutritional Physiological Phenomena; Animals; Ascorbic Acid; Body Weight; Ceruloplasmin; Copper; Diet; Drug Interactions; Female; Hematocrit; Hemoglobins; Iron; Kidney; Liver; Myocardium; Organ Size; Oxidoreductases; Rats; Rats, Inbred Strains; Spleen; Xanthine Dehydrogenase; Xanthine Oxidase; Zinc

Topics: Adolescent; Adult; Anemia; Ascorbic Acid; Calcium Gluconate; Child, Preschool; Energy Metabolism; Female; Food, Fortified; Humans; Iron; Male; Minerals; Models, Biological; N-substituted Glycines; Oxygen Consumption; Panax; Physical Endurance; Plants, Medicinal; Pollen; Propylamines; Vitamin B Complex; Vitamin E; Vitamins

With reference to a case of vitamin C deficiency in a strict vegetarian, the authors recall the clinical findings and current diagnostic procedures in scurvy. Serum and urine ascorbic acid assays are now available and established the diagnosis. Management rests upon vitamin C given in a curative dosage of 1 to 2 g per day for 15 days followed by a preventive dosage of 10 mg per day.

Topics: Adult; Anemia; Ascorbic Acid; Ascorbic Acid Deficiency; Diet; Humans; Male; Purpura; Scurvy

Topics: Anemia; Ascorbic Acid; Deferoxamine; Genes, Recessive; Hemochromatosis; Humans; Intestinal Absorption; Iron; Transfusion Reaction

Topics: Adolescent; Adult; Aged; Anemia; Ascorbic Acid; Chloramines; Female; Filtration; Humans; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Water Pollutants; Water Pollutants, Chemical

Topics: Adolescent; Adult; Anemia; Ascorbic Acid; Blood; Diet; Female; Hemoglobins; Humans; Iron; Iron Deficiencies; Menstruation Disturbances; Running; Sports Medicine

1. Urinary iron excretion after desferrioxamine has been examined in nine patinets with different iron-loading anaemias. Particular attention has been paid to individual variation in response and the kinetics of iron removal in order to determine the most efficient and convenient method of administration. 2. Twelve-hour subcutaneous infusions of desferrioxamine were comparable with intravenous infusions and gave a mean value of 62% more iron excretion than similar intramuscular bolus doses (range 20--125%). 3. Increasing doses as 12 h subcutaneous infusions produced a linear increase in iron excretion, which was followed by a tendency to reach a plateau. Iron excretion varied greatly between patients, was not related solely to age or estimated iron load, and in most cases was increased by ascorbic acid saturation. 4. Maximum iron-excretion rates were achieved after 3--6 and then maintained throughout an infusion. With bolus injections excretion rates declined rapidly after the first 6 h, during which approximately 60% of the total iron excretion occurred. 5. The dose and method of administration should be 'tailor-made' for each patient. Overnight 12 h subcutaneous infusions can be both as effective as similar doses given over 24 h and a practical way of achieving substantial negative iron balance. 6. Since children receiving regular blood transfusions for congenital anaemias such as thalassaemia usually die at the end of the second decade, this approach to iron chelation offers the possibility of alleviating what have hitherto been fatal-iron loading states.

Topics: Adolescent; Adult; Anemia; Ascorbic Acid; Child; Child, Preschool; Deferoxamine; Humans; Infusions, Parenteral; Injections, Intramuscular; Iron; Iron Chelating Agents

Indices of nutritional state were measured in 105 surgical patients. The indices were chosen to give information on protein-calorie malnutrition, anaemia, vitamin deficiency. Abnormal values for the various indices were common in the group as a whole and most frequent (50%) in patients who were still in hospital more than a week after major surgery. These patients had a high frequency of anaemia, vitamin deficiency, weight-loss, loss of arm-muscle bulk, and low plasma levels of transferrin and albumin. These abnormalities had gone almost entirely unrecognised, even in patients with sepsis after major surgery, who would benefit from improvement in nutritional state.

Topics: Adolescent; Adult; Aged; Anemia; Anthropometry; Ascorbic Acid; Ascorbic Acid Deficiency; Avitaminosis; Body Weight; England; Female; Folic Acid; Hemoglobins; Humans; Male; Middle Aged; Nutritional Requirements; Protein-Energy Malnutrition; Serum Albumin; Surgical Procedures, Operative; Transferrin; Vitamin B Complex; Vitamin B Deficiency

In two dialysis centres in the same city, with a total of 56 patients on regular dialysis treatment, it has been shown that the tap water used for the production of the dialysate contains chloramines. Total chlorine concentration and percentage of chloramines varies from 0.5 to 1.1 ppm and from 40 to 95 per cent. There in a high percentage of Heinz bodies in the patients' erythrocytes, and incubation of red cells in vitro with the dialysate raises the methaemoglobin concentration and alters the hexose-monophosphate shunt. The patients' mean haematocrit improved from 23.13 +/- 4.41 SD to 25.93 +/- 5.17 SD (p less than 0.0025) with the administration of ascorbic acid, 500 mg given intravenously once a week, but an unexpected transitory increase of the total chlorine to 3.5 ppm resulted in a serious decline of the mean haematocrit to 20.80 +/- 5.22 SD (p less than 0.0001). Ascorbic acid added to the dialysate at a concentration of 1.7 mg/dl produced a great improvement in the anaemia and the almost total disappearance of Heinz bodies from the patients' red cells.

Topics: Anemia; Ascorbic Acid; Chloramines; Heinz Bodies; Hematocrit; Humans; Kidney Failure, Chronic; Renal Dialysis; Water Supply

Rats fed a vitamin E-deficient diet containing 10% "stripped" corn oil had reduced growth rate and elevated platelet count by 12 weeks of age, and a normocytic anemia with elevated reticulocytes by 16 weeks of age. After 5 months, rats became emaciated and developed kyphoscoliosis. Some rats developed skin ulcers and tremors, and mortality was high. Neuromuscular lesions included a chronic necrotizing myopathy and localized axonal dystrophy. There was also a selective activation of lysosomes in the central nervous system microcirculation. Liver ascorbic acid of deficient rats was the same as in those receiving vitamin E. Urinary excretion of p-hydroxyphenylpyruvate after a tyrosine load was also the same in deficient and control rats. It was concluded that neither vitamin C synthesis or utilization was affected the E-deficient rats.

Topics: Age Factors; Anemia; Animals; Ascorbic Acid; Female; Kyphosis; Male; Muscular Diseases; Necrosis; Nervous System Diseases; Rats; Scoliosis; Skin Ulcer; Thrombocytosis; Vitamin E Deficiency

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Pernicious; Ascorbic Acid; Bone Marrow Diseases; Female; Humans; Iron; Male; Pyridoxine; Vitamin B 12

The study deals with investigations on anaemia due to iron or protein calorie deficiency and that associating acute glomerulonephritis, nephrosis and schistosoma haematobium. The rate of intestinal iron absorption using an oral dose of ferrous sulphate equivalent to 4 mg clemental iron/kg body weight was studied. The supplementing action of ascorbic acid in iron absorption in these cases was also investigated. The rate of intestinal iron absorption was enhanced in pure iron deficiency anaemia, acute glomerulonephritis and schistosoma haematobium, retarded in kwashiorkor, marasmus and nephrosis. Ascorbic acid markedly promoted iron absorption in normal subjects but slightly in pure iron deficiency anaemia. It improved iron absorption in acute glomerulonephritis and schistosoma haematobium but not in kwashiorkor, marasmus and nephrotic cases. It is concluded that ascorbic acid supplementation is of certain beneficial effect in alleviating the state of anaemia when intestinal iron absorption is not impaired. Also, it may prove to be of value to be given along with protein rehabilitation in anaemias associating protein deficiency.

Topics: Anemia; Anemia, Hypochromic; Ascorbic Acid; Child, Preschool; Egypt; Female; Glomerulonephritis; Humans; Infant; Intestinal Absorption; Iron; Male; Protein-Energy Malnutrition; Schistosomiasis

The observations on seventy patients with migratory glossitis and follow-up experiences over a period of 10 years are recorded. Women represented 65.7 per cent of the total, and most cases occurred in patients over 40 years of age. In 20 per cent of the patients other anomalies of the tongue were associated, and in 20 per cent subjective complaints were associated with psychic stress. Histologic investigations showed an inflammatory reaction of the epithelium and of the underlying connective tissue. The patient must be reassured of the benign nature of the tongue lesion. At follow-up examination, the lesions were present but no malignant change was observed.

Topics: Acridines; Adolescent; Adult; Age Factors; Aged; Anemia; Antifungal Agents; Ascorbic Acid; Child; Child, Preschool; Female; Follow-Up Studies; Glossitis, Benign Migratory; Gonadal Steroid Hormones; Humans; Infant; Iron; Male; Middle Aged; Mouthwashes; Sex Factors; Time Factors; Vitamin A; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Hypochromic; Anemia, Sickle Cell; Anemia, Sideroblastic; Ascorbic Acid; Black People; Blood Proteins; Child Nutritional Physiological Phenomena; Child, Preschool; Diet; Diet Surveys; Dietary Proteins; Erythrocytes; Hematocrit; Hemoglobins; Humans; Iron; Mass Screening; Mississippi; Protein Binding; Transferrin

Topics: Adolescent; Adult; Aged; Anemia; Ascorbic Acid; Child, Preschool; Deferoxamine; Drug Therapy, Combination; Female; Humans; Iron; Liver Diseases; Lymphoma; Male; Middle Aged

Topics: Alcohol Oxidoreductases; Anemia; Animals; Ascorbic Acid; Body Weight; Cadmium; Cadmium Poisoning; Esterases; Hepatitis, Animal; Ketones; Kidney; Liver; Male; Pentoses; Poisoning; Rats; Sugar Acids

Topics: Adult; Anemia; Ascorbic Acid; Blood Transfusion; Carcinoma, Squamous Cell; Citrus; Diet; Epistaxis; Female; Gastrointestinal Diseases; Hemoglobins; Humans; Intestinal Absorption; Iron; Leukocytes; Male; Middle Aged; Peptic Ulcer; Pharyngeal Neoplasms; Scurvy; Smoking; Stomatitis, Aphthous

Topics: Administration, Oral; Amino Acid Metabolism, Inborn Errors; Amino Acids; Anemia; Ascorbic Acid; Diagnosis, Differential; Hepatitis; Humans; Infant, Newborn; Infant, Premature, Diseases; Jaundice, Neonatal; Male; Rickets; Tyrosine

Topics: Anemia; Animals; Antioxidants; Ascorbic Acid; Birds; Body Weight; Bone and Bones; Cadmium; Cadmium Poisoning; Calcium; Copper; Deficiency Diseases; Depression, Chemical; Erythrocytes; Growth; Hematocrit; Hemoglobins; Iron; Kidney; Liver; Metals; Poisoning; Stereoisomerism; Zinc

Topics: Anemia; Ascorbic Acid; Buffers; Copper; Indicators and Reagents; Iron; Spectrophotometry; Triazines

Topics: Alopecia; Anemia; Animals; Ascorbic Acid; Bone and Bones; Bone Diseases; Calcium; Copper; Deficiency Diseases; Diet; Electron Transport Complex IV; Iron; Liver; Myocardium; Phosphorus; Rabbits

Topics: Anemia; Ascorbic Acid; Deficiency Diseases; Growth Disorders; Hepatomegaly; Humans; Infant; Male; Rickets; Scurvy; Splenomegaly; Thrombocytopenia; Vitamin D

Feeding the environmental toxicant cadmium to young Japanese quail for 4 weeks produced growth retardation, severe anemia, low concentrations of iron in the liver, and high concentrations of cadmium in the liver. Dietary ascorbic acid supplements almost completely prevented the anemia and improved the growth rate but did not markedly alter concentrations of iron or cadmium in the liver.

Topics: Anemia; Animals; Ascorbic Acid; Birds; Cadmium; Copper; Drug Antagonism; Environmental Exposure; Female; Growth Disorders; Hematocrit; Iron; Liver; Male; Trace Elements; Zinc

Topics: Anemia; Ascorbic Acid; Child; Child Nutritional Physiological Phenomena; Child, Preschool; Diet; Dietary Carbohydrates; Dietary Proteins; Female; Folic Acid; Food Analysis; Hematocrit; Hemoglobinometry; Humans; Infant; Iron; Male; Nigeria; Nitrogen

Topics: Adrenal Glands; Anemia; Animals; Ascorbic Acid; Chemical Industry; Environmental Exposure; Environmental Health; Maximum Allowable Concentration; Methemoglobinemia; Mice; Occupational Medicine; Phenols; Rabbits; Rats; Skin Absorption

Topics: Adult; Anemia; Ascorbic Acid; Climate; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications, Hematologic; Riboflavin; Tajikistan; Thiamine; Vitamin A; Vitamins

Topics: Aged; Anemia; Ascorbic Acid; Ascorbic Acid Deficiency; Edema; Hematoma; Humans; Hydrarthrosis; Male; Middle Aged; Scurvy; Single Person

Topics: Anemia; Animals; Ascorbic Acid; Breast Feeding; Child, Preschool; Environment; Ergocalciferols; Female; Fish Oils; Food Additives; Housing; Humans; Hypercalcemia; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Milk; Rickets; Scotland; Social Conditions; United Kingdom; Vitamin D; Vitamin D Deficiency

Topics: Aged; Anemia; Ascorbic Acid; Ascorbic Acid Deficiency; Diet Therapy; Humans; Nutritional Requirements; Scurvy

Topics: Adolescent; Adult; Aged; Anemia; Ascorbic Acid; Cachexia; Child; Female; Herpes Zoster; Humans; Liver Diseases; Male; Middle Aged; Neuralgia; Neuritis; Vascular Diseases; Vitamin B Complex

Topics: Adult; Aged; Anemia; Ascorbic Acid; Ascorbic Acid Deficiency; Female; Folic Acid; Humans; Leucovorin; Male; Middle Aged; Scurvy

Topics: Adolescent; Adult; Aged; Anemia; Ascorbic Acid; Female; Fumarates; Glutathione; Humans; Intestinal Absorption; Iron; Iron Isotopes; Male; Middle Aged; Orotic Acid

Topics: Aged; Anemia; Ascorbic Acid; Humans; Iron; Male; Scurvy; Vitamin B 12

Topics: Anemia; Ascorbic Acid; Delayed-Action Preparations; Female; Genital Diseases, Female; Humans; Iron; Pregnancy; Pregnancy Complications, Hematologic; Vitamin B Complex

Topics: Anemia; Anemia, Pernicious; Ascorbic Acid; Humans; Intrinsic Factor; Vitamin B Complex

Topics: Anemia; Anemia, Sickle Cell; Ascorbic Acid; Counseling; Eugenics; Galactosemias; Genetics, Medical; Humans; Immunity; Malaria; Metabolism, Inborn Errors; Phenylketonurias; Preventive Medicine

Topics: Anemia; Anemia, Hypochromic; Ascorbic Acid; Biochemical Phenomena; Biochemistry; Death, Sudden; Drug Therapy; Humans; Infant; Infant Nutritional Physiological Phenomena; Metabolism; Radiography; Scurvy

Topics: Anemia; Ascorbic Acid; Drug Therapy; Geriatrics; Humans; Iatrogenic Disease; Scurvy

Topics: Anemia; Anemia, Hypochromic; Ascorbic Acid; Blood Chemical Analysis; Chlorides; Ferritins; Hematocrit; Hemoglobins; Humans; Intestinal Absorption; Iron; Iron Isotopes; Nutritional Physiological Phenomena; Nutritional Sciences; Nutritional Status; Nutritive Value; Sulfates; Transferrin; Triticum

Topics: Adolescent; Anemia; Ascorbic Acid; Child; Corrinoids; Folic Acid; Geriatrics; Humans; Injections, Intravenous; Liver Diseases; Niacinamide; Syndrome; Vitamin B 12; Vitamin B Complex; Vitamins

Topics: Acatalasia; Anemia; Anemia, Hemolytic; Ascorbic Acid; Azides; Catalase; Cyanides; Erythrocyte Aging; Erythrocytes; Ethylmaleimide; Genetics, Medical; Glucose; Glucosephosphate Dehydrogenase Deficiency; Glucosephosphates; Glutathione; Hemoglobins; Hemolysis; Hexosephosphates; Humans; Metabolism, Inborn Errors; Methemoglobin; Peroxides; Pharmacology; Phenylhydrazines; Primaquine; Sulfhemoglobin; Sulfhydryl Compounds

Topics: Anemia; Animals; Ascorbic Acid; Biological Transport; Cyanides; Dinitrophenols; Ethylmaleimide; Female; In Vitro Techniques; Intestinal Absorption; Intestinal Mucosa; Iron; Iron Isotopes; Phenylhydrazines; Rats

Topics: Anemia; Ascorbic Acid

Topics: Anemia; Anemia, Sickle Cell; Ascorbic Acid; Child; Erythrocytes, Abnormal; Erythropoiesis; Folic Acid; Humans; Infections; Pathology; Reticulocytes

Topics: Anemia; Anemia, Hypochromic; Animals; Animals, Newborn; Ascorbic Acid; Blood Volume Determination; Diet; Dietary Supplements; Fumarates; Gluconates; Hemoglobinometry; Iron; Lactates; Research; Sorbitol; Swine; Vitamin E

Topics: Anemia; Anemia, Hypochromic; Ascorbic Acid; Body Weight; Carbohydrate Metabolism; Digestion; Gastrectomy; Humans; Lipid Metabolism; Proteins

Topics: Anemia; Anemia, Macrocytic; Ascorbic Acid; Blood Cell Count; Bone Marrow Examination; Erythropoiesis; Folic Acid; Geriatrics; Glutamates; Hematocrit; Hemoglobinometry; Humans; Iron; Liver Diseases; Liver Extracts; Phosphatidylethanolamines; Pyridoxine; Reticulocytes; Sulfobromophthalein; Urine; Vitamin B 12

Topics: Alcoholism; Anemia; Anemia, Macrocytic; Anorexia Nervosa; Ascorbic Acid; Avitaminosis; Celiac Disease; Deficiency Diseases; Diet; Diet Therapy; Female; Folic Acid; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Pregnancy Complications; Sprue, Tropical; United Kingdom; Vitamin A; Vitamin B 12; Vitamin B Complex; Vitamin D; Vitamin K; Vitamins; Vomiting

Topics: Achlorhydria; Anemia; Ascorbic Acid; Blood Transfusion; Folic Acid; Geriatrics; Humans; Scurvy; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Antacids; Ascorbic Acid; Esophagitis; Hematemesis; Hernia, Diaphragmatic; Hernia, Hiatal; Iron; Melena; Phlebitis; Physiology; Radiography; Stomach Volvulus; Surgical Procedures, Operative

Topics: Anemia; Arteriosclerosis; Ascorbic Acid; Humans; Intracranial Arteriosclerosis; Liver Diseases; Mental Disorders; Pyridoxine; Vitamins

Topics: Anemia; Anemia, Aplastic; Ascorbic Acid; Bone Marrow; Bone Marrow Transplantation; Humans; Pyridoxine; Testosterone; Twins; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Ascorbic Acid; Blood Transfusion; Deficiency Diseases; Humans; Infant; Iron; Leukocytosis; Rickets; Splenomegaly; Vitamin D; Vitamins

Measurement of the serum Lactobacillus casei (;folic-acid') activity is widely used as an index of folic-acid deficiency. Present methods of assay result in recovery of about half the active material in normal serum. A modified method of assay is described which gives higher L. casei values and a clearer distinction between the sera of normal subjects and of patients with folic-acid deficiency.

Topics: Anemia; Anemia, Macrocytic; Ascorbic Acid; Biological Assay; Blood; Folic Acid; Folic Acid Deficiency; Humans; Lactobacillus; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Pernicious; Ascorbic Acid; Clinical Enzyme Tests; Dehydroascorbic Acid; Erythrocytes; Hemolysis; Humans; Oxidoreductases; Vitamin B 12

Topics: Adenosine Triphosphate; Anemia; Anemia, Hemolytic; Ascorbic Acid; Blood Chemical Analysis; Blood Glucose; Carbon Dioxide; Erythrocyte Count; Erythrocytes; Geriatrics; Glucosephosphate Dehydrogenase; Glutathione; Hemoglobinometry; Hemolysis; Kidney Diseases; Metabolism; Methemoglobinemia; Nucleosides; Pyelonephritis; Renal Insufficiency; Sulfamethizole; Sulfathiazoles; Sulfonamides; Toxicology; Urinary Catheterization

Topics: Anemia; Anemia, Aplastic; Ascorbic Acid; Benzene; Corrinoids; Diagnosis; Humans; Occupational Diseases; Pancytopenia; Pyridoxine; Toxicology; Vitamin B 12

Topics: Anemia; Ascorbic Acid; Calcium; Calcium, Dietary; Diet; Dietary Proteins; Ethnology; Female; Humans; Iron; Israel; Jews; Judaism; Nutrition Surveys; Pregnancy; Prenatal Exposure Delayed Effects; Riboflavin; Social Class; Social Conditions; Vitamin A

Topics: Aminosalicylic Acid; Aminosalicylic Acids; Anemia; Anemia, Hemolytic; Ascorbic Acid; Drug Therapy; Favism; Glucosephosphate Dehydrogenase Deficiency; Glucosephosphates; Metabolism; Pharmacology; Toxicology; Tuberculosis; Tuberculosis, Cutaneous

Topics: Anemia; Ascorbic Acid; Blood Chemical Analysis; Child; Deficiency Diseases; Gastroenteritis; Humans

Topics: Anemia; Anemia, Macrocytic; Ascorbic Acid; Ascorbic Acid Deficiency; Blood Cell Count; Blood Chemical Analysis; Blood Coagulation Tests; Blood Proteins; Bone Marrow Examination; Folic Acid; Gastric Acidity Determination; Geriatrics; Hemoglobins; Hemolysis; Hemorrhagic Disorders; Humans; Scurvy; Urine; Urobilin

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Ascorbic Acid; Folic Acid; Humans; Metabolism; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Sideroblastic; Ascorbic Acid; Child; Folic Acid; Humans; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Ascorbic Acid; Blood Transfusion; Humans; USSR

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Ascorbic Acid; Humans; Osteoporosis; Scurvy

Topics: Anemia; Ascorbic Acid; Cobalt; Humans; Injections, Intramuscular; Uremia; Urologic Diseases

Topics: Anemia; Anemia, Hypochromic; Anemia, Sideroblastic; Ascorbic Acid; Genetic Diseases, X-Linked; Humans; Iron; Pyridoxine

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Ascorbic Acid; Blood Transfusion; Child; Diarrhea; Folic Acid; Humans; Infant; Infections; Nutrition Disorders

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Anemia; Anemia, Aplastic; Ascorbic Acid; Classification; Corrinoids; Electrocardiography; Folic Acid; Humans; Liver Extracts; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Ascorbic Acid; Asian People; Blood Chemical Analysis; Bone Marrow Examination; Dietary Carbohydrates; Dietary Proteins; Folic Acid; Folic Acid Deficiency; Leucovorin; Lipids; Myanmar; Vitamin B 12

Topics: Adrenocorticotropic Hormone; Anemia; Anemia, Myelophthisic; Anti-Bacterial Agents; Ascorbic Acid; Benzene; Biopsy; Blood Transfusion; Cortisone; Female; Hematologic Diseases; Hematology; Leukemia; Liver Extracts; Mortality; Occupational Diseases; Pathology; Poisoning; Prednisolone; Prednisone; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Tetracycline; Toxicology; Vasopressins; Vitamin B 12

Topics: Anemia; Anemia, Aplastic; Ascorbic Acid; Bilirubin; Blood Cell Count; Blood Chemical Analysis; Blood Transfusion; Bone Marrow Examination; Child; Flavonoids; Folic Acid; Hematopoietic System; Humans; Infant; Infant, Newborn; Leukopenia; Osteoporosis; Prednisolone; Prednisone; Pyridoxine; Radiography; Riboflavin; Testosterone; Thiamine; Thrombocytopenia; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Ascorbic Acid; Blood Transfusion; Erythrocytes; Humans; Statistics as Topic; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Aplastic; Ascorbic Acid; Blood Transfusion; Child; Corrinoids; Cortisone; Diagnosis; Humans; Iron; Rutin; Vitamin B 12; Vitamin K

Topics: Anemia; Ascorbic Acid; Folic Acid; Vitamin B 6; Vitamins

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Ascorbic Acid; Female; Folic Acid; Humans; Postpartum Period; Puerperal Disorders

Topics: Anemia; Anemia, Hypochromic; Ascorbic Acid; Ferrous Compounds; Fumarates; Hematologic Diseases; Humans; Iron

Topics: Anemia; Ascorbic Acid; beta-Thalassemia; Child; Humans; Infant; Plasma; Thalassemia

Topics: Anemia; Anemia, Sideroblastic; Ascorbic Acid; Hemochromatosis; Humans; Pyridoxine; Vitamin B 6; Vitamins

Topics: Anemia; Animals; Ascorbic Acid; Cestode Infections; Diphyllobothriasis; Diphyllobothrium; Humans

Topics: Anemia; Anemia, Pernicious; Ascorbic Acid; Bone Marrow; Folic Acid; Humans; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Ascorbic Acid; Humans; Iron; Peptic Ulcer; Vitamins

Topics: Anemia; Anemia, Pernicious; Ascorbic Acid; Ascorbic Acid Deficiency; Erythrocytes; Humans

Topics: Achlorhydria; Anemia; Anemia, Hypochromic; Ascorbic Acid; Gastrectomy; Humans; Iron; Vitamins

Topics: Anemia; Ascorbic Acid; Hemorrhage; Humans; Iron; Vitamins; Volunteers

Topics: Anemia; Ascorbic Acid; Folic Acid; Gastric Juice; Humans; Vitamin B 12

Topics: Achlorhydria; Aged; Anemia; Ascorbic Acid; Hematologic Diseases; Humans; Iron; Polycythemia Vera; Vitamin B 12

Topics: Anemia; Anemia, Pernicious; Ascorbic Acid; Erythroid Cells; Hematopoietic System

Topics: Anemia; Ascorbic Acid; Iron; Papain; Peptide Hydrolases; Phenylhydrazines

Topics: Anemia; Animals; Ascorbic Acid; Chickens; Diet; Folic Acid; Paralysis; Paresis; Riboflavin; Vitamin A; Vitamin B Complex; Vitamins

Topics: Adult; Anemia; Anemia, Megaloblastic; Ascorbic Acid; Humans; Scurvy

Topics: Anemia; Ascorbic Acid; Child; Humans; Infant; Iron; Vitamins

Topics: Anemia; Anemia, Hypochromic; Ascorbic Acid; Female; Genital Diseases, Female; Humans; Iron; Vitamins

Topics: Acetates; Anemia; Anemia, Macrocytic; Ascorbic Acid; Chromatography; Phenylacetates; Scurvy; Steatorrhea; Urine

Topics: Anemia; Anemia, Pernicious; Ascorbic Acid; Diploidy

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Ascorbic Acid; Ferrous Compounds; Iron Compounds

Topics: Aminosalicylic Acid; Anemia; Anemia, Hemolytic; Ascorbic Acid; Pharmaceutical Solutions

Topics: Adult; Anemia; Ascorbic Acid; Humans; Scurvy; Vitamins

Topics: Anemia; Ascorbic Acid; Humans; Iodides; Minerals; Niacin; Nicotinic Acids; Vitamin B 12; Vitamin B Complex; Vitamins

Topics: Anemia; Ascorbic Acid; Folic Acid; Humans; Scurvy; Vitamins

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Ascorbic Acid; Iron; Iron Compounds; Vitamins

Topics: Anemia; Ascorbic Acid; Folic Acid; Humans; Vitamins

Topics: Alloxan; Anemia; Animals; Ascorbic Acid; Diabetes Mellitus; Spiders; Tracheophyta; Vitamins

Topics: Alloxan; Anemia; Ascorbic Acid; Erythrocytes; Globins; Heinz Bodies; Humans; Metalloporphyrins

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Animals; Ascorbic Acid; Folic Acid; Folic Acid Deficiency; Scurvy; Tracheophyta

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Ascorbic Acid; Humans; Pregnancy; Vitamin B 12

Topics: Anemia; Ascorbic Acid; Cobalt; Humans; Iron; Iron Compounds; Manganese; Vitamins

Topics: Anemia; Anemia, Megaloblastic; Ascorbic Acid; Folic Acid; Humans; Tracheophyta; Vitamins

Topics: Anemia; Ascorbic Acid; Humans; Iron; Malaria

Topics: Anemia; Ascorbic Acid; Humans; Iron; Vitamins

Topics: Anemia; Ascorbic Acid; Child; Humans; Iron