losartan-potassium and Deficiency-Diseases

Prematurity, maternal diabetes, maternal smoking, being medically underserved, and small size for gestational age are common characteristics of neonates in the NICU and can predispose them to develop congenital iron deficiency. Iron is critical for organ development. In the fetus and newborn, iron is prioritized for red blood cell production, sometimes at the expense of other tissues, including the brain. It is critical to optimize iron levels in newborns to support erythropoiesis, growth, and brain development. Available studies support improved neurodevelopmental outcomes with either iron supplementation or delayed umbilical cord clamping at birth. Erythropoietic doses of erythropoietin/erythrocyte-stimulating agents may also improve neurocognitive outcomes. However, the literature on the effect of liberal red blood cell transfusions on long-term neurodevelopment is mixed. Understanding age-specific normal values and monitoring of iron indices can help individualize and optimize the iron status of patients in the NICU.

Topics: Anemia, Neonatal; Child Development; Deficiency Diseases; Erythrocyte Transfusion; Erythrocytes; Erythropoiesis; Erythropoietin; Hematinics; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Iron; Iron Deficiencies

Topics: Animals; Blood Cell Count; Blood Platelets; Blood Volume; Child; Deficiency Diseases; Erythropoietin; Hemorrhage; Hookworm Infections; Humans; Iron; Iron Deficiencies; Megakaryocytes; Thrombocytopenia; Thrombocytosis

Pure red cell aplasia is a selective aplasia of the marrow erythroid cells. Unlike aplastic anemia, the marrow has a normal cellularity and the patients generally have normal leukocyte and platelet blood counts. The congenital form of the disease occurs in the firlst 1 1/2 years of life and is often responsive to corticosteroids. The acquired form may be secondary to infections, drugs, chemicals, or hemolytic anemia (aplastic crisis). In these cases it is often acute and self-limited with cessation of the infection or drug ingestion. It may also be secondary to systemic lupus erythematosus, rheumatoid arthritis, acute severe renal failure, severe nutritional deficiency, or diverse neoplasms, and may remit with treatment of the primary condition. When a thymoma is present, it should be resected since a remission is produced in 29 per cent of these patients. The remaining patients have an acquired primary form of the disease that tends to be chronic and in some cases may have an immune pathogenesis. A cytotoxic immunoglobulin inhibitor of the marrow erythroid cells or erythropoietin has been described and these patients may respond to prednisone and/or to cytotoxic immunosuppressive drugs such as cyclophosphamide and 6-mercaptopurine. Pure red cell aplasia appears to be more common than the literature has revealed and has stimulated much investigation into an immune pathogenesis for marrow failure.

Topics: Acute Kidney Injury; Anemia, Aplastic; Antilymphocyte Serum; Arthritis, Rheumatoid; Blood Cell Count; Blood Transfusion; Cyclophosphamide; Deficiency Diseases; Erythropoietin; Humans; Immune System Diseases; Infections; Lupus Erythematosus, Systemic; Mercaptopurine; Prednisone; Remission, Spontaneous; Splenectomy; Thymoma; Thymus Neoplasms

Topics: Anemia; Animals; Deficiency Diseases; Diphosphoglyceric Acids; Erythrocytes; Erythropoiesis; Erythropoietin; Female; Hemoglobins; Humans; Infant, Newborn; Iron; Lactation; Oxygen; Pregnancy

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Anabolic Agents; Anemia, Aplastic; Bone Marrow; Bone Marrow Transplantation; Capillaries; Deficiency Diseases; Erythropoietin; Hepatitis; Humans; Lectins; Splenectomy; Testosterone

Antenatal iron and multiple micronutrient supplementation has been shown in randomized trials to improve birthweight, although mechanisms are unknown. We examined late pregnancy serum erythropoietin (EPO) and cortisol concentrations in relation to maternal micronutrient supplementation and iron status indicators (haemoglobin, serum ferritin, soluble transferrin receptor) in 737 rural Nepalese women to explore evidence of stress or anaemia-associated hypoxia. A double-masked randomized control trial was conducted from December 1998 to April 2001 in Sarlahi, Nepal, in which women received vitamin A alone (as control), or with folic acid (FA), FA + iron, FA + iron + zinc and a multiple micronutrient supplement. In a substudy, we collected maternal blood in the first and third trimester for biochemical assessments. Generalized estimating equations linear regression analysis was used to examine treatment group differences. EPO was ∼ 14-17 mIU mL(-1) lower (P < 0.0001) in late pregnancy in groups receiving iron vs. the control group, with no difference in the FA-only group. Cortisol was 1.3 μg dL(-1) lower (P = 0.04) only in the micronutrient supplement group compared with the control group. EPO was most strongly associated with iron status indicators in groups that did not receive iron, and in the non-iron groups cortisol was positively correlated with EPO (r = 0.15, P < 0.01) and soluble transferrin receptor (sTfR, r = 0.19, P < 0.001). In adjusted analyses, third trimester EPO was associated with a reduction in low birthweight, whereas cortisol was negatively associated with length of gestation and higher risk of preterm birth. Iron and multiple micronutrient supplementation may enhance birth outcomes by reducing mediators of maternal stress and impaired erythropoiesis.

Topics: Adult; Anemia, Iron-Deficiency; Biomarkers; Deficiency Diseases; Developing Countries; Dietary Supplements; Double-Blind Method; Erythropoietin; Female; Humans; Hydrocortisone; Iron, Dietary; Maternal Nutritional Physiological Phenomena; Micronutrients; Nepal; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Third; Premature Birth; Risk; Rural Health; Young Adult

The purpose of this article was to determine the prevalence of iron, vitamin B12, and folate deficiency and to evaluate the erythropoietin (EPO) response to anemia in a cohort of long-term intensive care unit (ICU) patients.. All patients admitted to three academic medical center multidisciplinary ICUs were screened for eligibility into a randomized trial of EPO for the treatment of ICU anemia. On their second or third ICU day, patients enrolled in this trial had EPO levels drawn and were screened for iron, B12, and folate deficiency. Weekly EPO levels were obtained throughout patients' ICU stay.. A total of 184 patients were screened for iron, B12, and folate deficiency. Sixteen patients (9%) were iron deficient by study criteria, 4 (2%) were B12 deficient, and 4 (2%) were folate deficient. Mean hemoglobin and reticulocyte percents of the remaining 160 patients were 10.3 +/- 1.2 g/dL and 1.66 +/- 1.09%, respectively. In most patients, serum iron and total iron binding capacity levels were very low, whereas ferritin levels were very high. Mean and median day 2 EPO levels were 35.2 +/- 35.6 mIU/mL and 22.7 mIU/mL, respectively (normal = 4.2-27.8). Serial EPO levels in most persistently anemic patients remained within the normal range.. In this cohort, screening for iron, B12, and folate deficiency identified potentially correctable abnormalities in more than 13% of patients and should be considered in those who are anticipated to have long ICU stays. Even at an early point of critical illness, most patients had iron studies consistent with anemia of chronic disease (ACD), as well as a blunted EPO response that may contribute to this ACD-like anemia of critical illness.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia; APACHE; Cohort Studies; Critical Illness; Deficiency Diseases; Erythropoiesis; Erythropoietin; Female; Folic Acid; Humans; Intensive Care Units; Iron; Iron Deficiencies; Male; Middle Aged; Recombinant Proteins; Vitamin B 12

Topics: Deficiency Diseases; Erythrocyte Count; Erythrocytes; Erythropoietin; Female; Hemoglobins; Humans; Iron Deficiencies; Male; Peritoneal Dialysis, Continuous Ambulatory; Prospective Studies; Renal Dialysis

We have encountered five hemodialysis patients who had received enteral nutrition and recovered from erythropoietin-resistant anemia with neutropenia after the correction of copper deficiency. We reduced the required doses of recombinant human erythropoietin (rHuEPO) to maintain the target hematocrit levels and three patients were finally weaned from the rHuEPO therapy. Thus, copper deficiency is involved in erythropoietin-resistant anemia in hemodialysis patients.

Topics: Anemia; Ceruloplasmin; Copper; Copper Sulfate; Deficiency Diseases; Enteral Nutrition; Erythropoietin; Female; Humans; Kidney Failure, Chronic; Middle Aged; Neutropenia; Recombinant Proteins; Renal Dialysis; Treatment Failure

So far the question has not been elucidated whether latent ESF-deficiency exists in patients with chronic renal disease during initial development of renal anemia. Therefore, ESF was determined in urine and serum of non anemic patients being exposed to acute hypoxia: 8 healthy volunteers and 8 patients who had a Ccreat below 48 ml/min were studied while in a hypobaric chamber for 4 subsequent periods of 10 h each (simulated maximal altitude 4000 m INA = 462 mm Hg). We also determined plasma iron turnover and reticulocyte counts. 10 h after the study began, the patients showed a significantly higher ESF-level than the normal volunteers. In the course of 48 h collection periods of urine under hypoxic conditions the mean ESF excretion in patients corresponded to 9.9 and in healthy persons to 7.3 Units. With regard to plasma iron turnover and reticulocyte count an increase was shown, but no significant differences existed between the two groups. A latent ESF-deficiency as the initial cause of renal anemia does not exist.

Topics: Adult; Chronic Disease; Deficiency Diseases; Erythrocyte Count; Erythropoietin; Female; Hematocrit; Hemoglobins; Humans; Hypoxia; Iron; Kidney Diseases; Male; Middle Aged

The effect of 6-methylprednisolone (GCC) was studied on erythropoietin (ESF) levels and on the metabolic functions of erythrocytes (RBC). GCC (U mg/kg/day for 15 days) was administered to 6 patients with the haemolytic-uraemic syndrome (group B) and to 6 patients with non-spherocytic haemolytic anaemia due to hereditary pyruvate kinase enzyme deficiency (group C). 6 healthy persons served as control (group A). The metabolic functions of RBC were investigated by assaying HMPS activity, GSH/GSSG and lactate/pyruvate ratios, relevant glycolytic intermediates, 2,3-DPG, ATP, and key enzymes. A significant increase in ESF was observed in group B patients after GCC therapy, correlating with an improvement in the haemolytic state, and consequent rectification of the secondary disturbances of RBC metabolism. Group C patients already had raised ESF levels before GCC therapy; no further increase occured in response to treatment and no other clinical or haematological change was recorded. Hence, no harmonal influence of GCC on the disturbed RBC metabolic process was detectable in the cases.

Topics: Adult; Anemia, Hemolytic, Congenital Nonspherocytic; Deficiency Diseases; Erythrocytes; Erythropoietin; Female; Hemolytic-Uremic Syndrome; Humans; Male; Methylprednisolone; Pyruvate Kinase

Topics: Adaptation, Physiological; Androgens; Anemia; Anemia, Hemolytic; Deficiency Diseases; Diet Therapy; Erythrocytes; Erythropoiesis; Erythropoietin; Hemolysis; Hemorrhage; Humans; Iron; Kidney Failure, Chronic; Nephrectomy; Oxygen Consumption; Renal Dialysis; Uremia; Vitamins

Topics: Animals; Ascorbic Acid; Cobalt; Cobalt Isotopes; Deficiency Diseases; Endotoxins; Erythropoietin; Escherichia coli; Ferritins; Immunoassay; Intestinal Absorption; Iron; Iron Isotopes; Iron-Dextran Complex; Male; Rabbits; Rats