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Introduction: Microcytic anemia is a type of anemia with smaller than normal red blood cells. Iron deficiency anemia and thalassemia are some of the major causes. The aim of the study was to compare the pulmonary function of the subjects with microcytic anemia to the respective results of the normal population., Material and Methods: This was a cross-sectional study in Bandar Abbas, Iran, conducted on the patients attending yearly occupational health checkups. Complete blood cell count and a standard spirogram were attained from each consenting participant and occupational histories of exposure to dust, fumes, solvents, and noxious gases were obtained., Results: At last, 2,199 subjects were included in the analysis, of which 335 cases had microcytic anemia. There was a significant association between having microcytic anemia and forced vital capacity (FVC) reduction, and to a lesser degree, the reduction of forced expiratory volume in the first second (FEV1). These parameters were also significantly increased together with the rise of mean corpuscular volume (MCV) in the sample population., Conclusion: It can be concluded that having microcytic anemia may reduce some spirometric parameters. Even though these changes are small, adjusting for the reduced values can help prevent an overestimation of lung disorders, mostly in borderline cases.

α°-thalassemia is a well-known cause of hydrops fetalis in South-East Asia and can be detected in utero. We report a very rare case of thyrotoxic cardiomyopathy associated with hyperplacentosis secondary to α°-thalassemia-associated hydrops fetalis. A 22-year-old primigravida with microcytic anemia presented at 27 weeks' gestation with pre-eclampsia, hyperthyroidism and cardiac failure. Serum β-human chorionic gonadotrophin was markedly elevated and abdominal ultrasound revealed severe hydropic features and enlarged placenta. Serum β-human chorionic gonadotrophin, cardiac function and thyroid function tests normalized after she delivered a macerated stillbirth. Histopathology of the placenta showed hyperplacentosis. Blood DNA analysis revealed that both patient and husband have the α°-thalassemia trait. This case illustrates a very atypical presentation of α°-thalassemia-associated hydrops fetalis and the importance of early prenatal diagnosis of α-thalassemia in women of relevant ethnic origin with microcytic anemia so that appropriate genetic counseling can be provided to reduce maternal morbidity and the incidence of hydrops fetalis., (© 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.)

The present paper reports a rare combination of Cooley's disease (thalassemia B) and the decompensated variant of chronic tonsillitis in a 14-year old girl. The patient presented with the severe form of hypochromic anemia and degenerative changes of erythrocytes. She was treated by means of bilateral tonsillectomy associated with the high risk of postoperative hemorrhage. In the preoperative period, the child received drop intravenous infusion of tranexam at a dose of 15 mg/kg body weight together with hemostatic agents. Hemorrhage during the surgical intervention was stopped by pressing tampons impregnated with tranexamic acid known to exert local and systemic hemostatic and antifibrinolytic action. The patient was discharged from the hospital for the further treatment of the primary disease.

Objective: To investigate the effects of iron supplement on function of mitochondrial respiratory of liver during exercise-induced hypochromic rats., Method: Forty healthy male Wistar rats were randomized into 5 groups (n = 8): static control (C), exercise-training (T), training with supplementation of small dose iron (S + T), training with supplementation of middle dose iron (M + T) and training with supplementation of large dose iron (L + T). Training performed incremental exercise for 8 weeks, 6 days/week, iron supplementation from the fifth week. Liver were prepared immediately after exhaustive running. Liver mitochondria were extracted by differential centrifugation. Spectrophotometric analysis was used to evaluate activities of electron transport chain complex (C) I-IV in liver mitochondria., Results: (1) C I, CII and CIV activities in T group were increased significantly (P < 0.05, P < 0.01), CI - C IV activities in S + T, M + T and L + T groups were increased significantly (P < 0.05, P < 0.01) compared with those in C group. (2) CII activity in S + T group was increased remarkably (P < 0.05); CIII and CIV activities in M + T group were increased remarkably (P < 0.01); CI - CIV activities in L+ T group were increased remarkably (P < 0.05, P < 0.01) compared with those in T group., Conclusion: Large load exercise training composite iron supplementation can improve function of mitochondrial respiration of liver and the aerobic capacity. From the athletic ability , the middle dose iron supplementation is better during large load exercise training.

The effect of canine intestinal helminths on the haematological profile of 200 dogs, of both sexes and variable age, visiting university veterinary clinics for routine examination was investigated. The dogs were assigned to parasitized (n = 39) and non-parasitized (n = 161) groups of animals. Coprological examination revealed a 19.5% prevalence of different species of the helminths. Of these animals, 10.25% had mixed infections with Ancylostoma caninum, Toxascaris spp. and Dipylidium caninum. The intensity of A. caninum infection was the highest, with mean egg counts of 951.43 (standard error 88.66), followed by Toxascaris 283.33 (standard error 116.81) and D. caninum. The parasitized animals had significantly lower levels of haemoglobin, packed cell volume and total erythrocyte counts than non-parasitized animals (P < 0.01). Values of other parameters, except for lymphocytes and eosinophils, were not different between the two groups. Analyses of the haematological profile revealed normocytic hypochromic anaemia in the parasitized group of animals.

Objectives: We aimed to evaluate the effectiveness of postoperative autotransfusion method on prevention of the need of allogeneic blood transfusion in hip and knee arthroplasty., Methods: Seventy-four patients who underwent 77 hip and knee arthroplasty operations were randomized into control and study groups, and evaluated prospectively. In the knee group (39 patients; 30 females, 9 males; mean age 66.6 years), cemented, cruciate retaining, and bicompartmental arthroplasty was performed under tourniquet control; whereas in the hip group (35 patients; 24 females, 11 males; mean age 59.3 years) cementless arthroplasty with posterolateral approach was performed. None of the patients received preoperative and intraoperative allogeneic blood transfusion. The collected blood in the surgical area was transfused with autotransfusion system to the patients in the study groups at the end of the fourth hour postoperatively. The mean amounts of autotransfused blood in hip and knee groups were 413 mL and 480 mL, respectively. Allogeneic blood transfusion was applied to the patients with hemoglobin level below 8 g/dL, hematocrit level below 25%, and clinical symptoms of anemia., Results: Preoperative and postoperative hemoglobin-hematocrit levels did not differ significantly between study and control groups. Allogeneic blood transfusion was applied to one patient (5%) in study and 8 patients (38%) in control groups during knee arthroplasty (p=0.01); whereas 9 patients (53%) in study and 15 patients (79%) in control groups received allogeneic blood transfusion during hip arthroplasty (p=0.044). The amount of allogeneic blood transfusion in study groups was significantly lower than that in control groups (p=0.008 for knee arthroplasty, p=0.048 for hip arthroplasty)., Conclusion: The need and amount of allogeneic transfusion were reduced with postoperative autotransfusion in both knee and hip arthroplasty groups with greater extent in knee arthroplasty.

Normochromic normocytic anemia during pregnancy reflects the significant increase in plasma volume, which disproportionately exceeds the increase in the red cell volume. In beta-thalassemia (beta-thal) trait carriers who become pregnant the plasma volume expansion may cause more pronounced anemia because the anemia of pregnancy is added to the pre-existed hypochromic microcytic anemia. In beta-thal women, pregnancy outcome and obstetric complications do not differ from the general population. Anemia in beta-thal carriers is generally not severe enough to warrant anxiety. No specific therapy is indicated and pregnant women generally require only supportive care with an anticipated favorable pregnancy outcome.

Chlorosis and Neurasthenia are two classical examples of pathological dissociations and the difficulties involved in approaching their diagnosis using scientific-naturalistic criteria. In the realm of those difficulties, the study examines the androcentric viewpoint and the ideological perspective of Contemporary Spanish Medicine when addressing the feminine nature and women's pathologies. Moreover, based on the similarities with present-day pain and fatigue syndromes, the study underlines the need to review the clinical approach to these illnesses by attempting to overcome the existing biomedical limitations.

Cancer-related anemia is a cytokine-mediated disorder resulting from complex interactions between tumor cells and the immune system. Overexpression of certain inflammatory cytokines results in shortened survival of red blood cells, suppression of erythroid progenitor cells, impaired iron utilization, and inadequate erythropoietin production. Numerous other factors may also contribute to the development of anemia in cancer patients. The European Cancer Anaemia Survey (ECAS) has provided the most current, comprehensive, prospectively collected data on the incidence and prevalence of anemia among cancer patients, as well as important perspectives on anemia treatment and relationship of hemoglobin and performance status. ECAS enrolled over 15,000 treated and untreated patients with various malignancies from cancer centers in 24 European countries and followed them for up to 6 months. The initial analysis of the ECAS data revealed that 39% of the total cancer patient population was anemic (hemoglobin <12.0 g/dl) at enrollment, although the rate varied according to tumor type, disease status, and cancer treatment status. Of the patients who were not anemic at enrollment and started cancer treatment during the survey, those undergoing chemotherapy--either alone or in combination with radiotherapy--had the highest incidence of anemia (63 and 42%, respectively). Low hemoglobin levels correlated with poor performance status and only 40% of patients who were anemic at some time during the survey received treatment for their anemia. These findings are noteworthy, since a growing body of clinical evidence indicates that the treatment of anemia can significantly improve patients' quality of life and may also improve the clinical outcome., (Copyright 2005 S. Karger AG, Basel)

Study Objectives: During isovolemic hemodilution, healthy individuals maintain oxygen consumption VO2 by identical increases in cardiac index (CI) and oxygen extraction ratio (O(2)ER). In critically ill patients, the relationship between CI and O(2)ER may be different. Patients with an altered cardiac function may have a decreased CI/O(2)ER ratio, whereas patients with sepsis may have an increased CI/O(2)ER ratio. We hypothesized that the analysis of the CI-O(2)ER relationship could help us to assess the adequacy of cardiac function in critically ill patients with anemia., Design: Prospective, observational study., Setting: Thirty-one-bed medicosurgical ICU of a university hospital., Patients: Sixty patients equipped with arterial and Swan-Ganz catheters presenting with anemia, which was defined as a hemoglobin level < or = 10 g/dL in the absence of active bleeding. Patients were classified into those with compromised cardiac function (group 1; n = 40), and those with normal cardiac function (group 2; n = 20)., Measurements and Results: In addition to the pertinent clinical data, initial hemodynamic measurements, including pulmonary artery occlusion pressure (PAOP), CI, and O(2)ER, were collected in all patients at the onset of anemia. As anticipated, group 1 patients (n = 40) had lower CIs, higher O(2)ER levels, and lower CI/O(2)ER ratios than group 2 patients. However, there was no significant difference in PAOP values between the groups. The CI/O(2)ER ratio was < 10 in 27 of 40 group 1 patients but only in 4 of 20 group 2 patients. Of these latter four patients, three were found to be hypovolemic, and one patient with sepsis had severe myocardial depression. There was no statistically significant difference in PAOP in group 2 patients with or without hypovolemia ([mean +/- SD] 12.3+/-2.1 mm Hg) vs 13.7+/-4.3 mm Hg; p = 0.21). In group 1, survivors had a higher CI and CI/O(2)ER ratio than nonsurvivors. In group 2, however, such a relationship did not reach statistical significance., Conclusions: The relationship between CI and O(2)ER level can help interpret the CI in anemic patients. In anemic patients with no cardiac history, a low CI/O(2)ER ratio (< 10) suggests hypovolemia even when CI is not depressed.

Object: To examine the hypothesis of Renz and Kalf relative to the involvement of interleukin 1 alpha (IL-1 alpha) in the development of anemia in benzene-exposed workers. According to this hypothesis, benzene inhibits the cleavage of the IL-1 alpha precursor (proIL-1 alpha) to mature IL-1 alpha and the lack of this cytokine is responsible for benzene-induced bone marrow suppression. This inhibition of the processing of proIL-1 alpha is attributed to an inhibition of calpain., Method: Selection of a population of mechanics exposed to low levels of benzene from fuels, assessment of usual exposure and lifetime exposure duration, and measurements of concentrations of workplace-air benzene and urinary benzene metabolites. Determination of IL-1 alpha concentrations was done by a whole-blood assay after lipopolysaccharide stimulation and a hematological examination was carried out. Statistical analysis considered several possible confounding factors, particularly smoking and drinking habits., Design: Cross-sectional study., Results: The level of exposure of the mechanics to benzene from fuels was mostly well below 1 ppm. IL-1 alpha production was not decreased in mechanics exposed to benzene from fuels, and no correlation between IL-1 alpha concentrations and red blood cell counts appeared. With the exception of a slight decrease in red blood cell counts in mechanics, no hint of a toxic effect of exposure on hematological parameters was found., Conclusions: The hypothesis of Renz and Kalf could not be confirmed. Although the low level exposure of the study population and methodological factors are possible explanations, it cannot be excluded that the hypothesis of Renz and Kalf is not generalizable to benzene-exposed humans. Presently, one cannot advise the measurement of IL-1 alpha production for biological effect monitoring of workers exposed to low concentrations of benzene.

Inherent in any decision to treat a patient for anemia is an appreciation of the underlying cause of a decrease in the oxygen-carrying capacity of blood. Equally important is an understanding of how this acute or chronic decrease in oxygen delivery affects individual patients. Anemia generally results from blood loss, decreased red blood cell (RBC) production, poor RBC maturation, or increased RBC destruction. This article reviews the pathophysiology of anemia, with specific emphasis on its physiologic consequences in the surgical patient, and provides a contemporary definition of anemia for use in that context. Taking a broader, more functional view of anemia paves the way for understanding and appreciating the newer techniques of RBC conservation and transfusion avoidance, as well as of pharmacologic methods available to counter this disorder.

Anaemia due to iron deficiency remains the commonest form of anaemia world-wide, predominantly due to blood loss, either associated with infestations such as hook worm or menstrual blood loss, or malnutrition. In Australia, iron deficiency anaemia is the commonest form of anaemia and is seen in pregnant and breastfeeding females where the iron balance is often in a negative state. Fads and fallacies abound, particularly in this group. Despite extensive knowledge of iron metabolism, diagnosis of iron deficiency often remains a difficult problem. The use of diagnostic tests available is discussed in this article.

Our study attempts to explore the mechanism by which iron deficiency anemia (IDA) affects the brain function of infants. We made auditory brainstem response (ABR) test for 48 IDA infants and 30 normal control infants, aged 6-36 months and reexamined ABR in 4 IDA infants after three months iron therapy. 26 cases of abnormal ABR among 48 IDA infants were found, it took 54.2% of total IDA infants. IDA led mainly to peripheral impairments of auditory system and rarely to brainstem. There was a direct relationship between the severity of IDA and the degree of abnormality of the ABR in infants. The threshold of ABR in IDA infants was significantly higher than that of in control group. It suggests that IDA infants have listening comprehensive difficulty as a result of impairment in high frequency hearing. After follow-up of 4 IDA infants, it was found that the impairment of auditory system could be reversible after prompt correcting of IDA. This observation has important significance for child health in the future.

Eighty iron-deficient, nonpregnant female workers were randomly assigned to ferrous sulphate (60 or 120 mg Fe/d) or placebo treatment for 12 wk. Energy expenditure was estimated during 3 d by heart rate (HR) recording. Production efficiency (PE) was calculated as the ratio of productivity to energy expenditure. In the iron-treated group mean hemoglobin (Hb) increased from 114 to 127 g/L (P < 0.001), mean serum ferritin increased from 9.7 to 30.0 micrograms/L (P < 0.001), and mean free erythrocyte protoporphyrin decreased from 1.01 to 0.49 mumol/L (P < 0.001). Mean HR at work decreased from 95.5 to 91.1 beats/min (P < 0.001), which was inversely correlated with the change in Hb (r = -0.60, P < 0.001). PE increased significantly in the iron-treated group (P < 0.001) and its change paralleled the change in Hb (r = 0.58, P < 0.001). The results show that iron supplementation enabled these women to do the same work at a lower energy cost.

Environmental factors that influence placental development are of particular interest because of the reported association between adult hypertension, low birthweight, and large placental size. Maternal anaemia is one environmental factor that is associated with an increase in placental size at birth. We have examined the relation between haematological status and plasma concentrations of chorionic gonadotropin (hCG) and placental lactogen (hPL) in 175 women at about 10 weeks of pregnancy. There were significant negative correlations between maternal haemoglobin concentration and the levels of hCG (p = 0.03) and hPL (p = 0.02). Although 21% of women had low iron stores (ferritin < 13 micrograms/L), no relation was found between serum ferritin and the two placental hormones. There was no association between plasma volume (calculated from maternal weight and height) and hCG or hPL concentrations. We conclude that our observations reflect an influence of the maternal environment on the placenta. The fact that negative correlations with placental hormone concentrations exist across the normal haemoglobin range suggest that they reflect a normal aspect of placental development. We speculate that placental growth is, in part, determined by maternal factors that prevail before conception. One possibility is that these factors modify angiogenesis within the trophoblastic villi.

Aim: To determine the prevalence of iron deficiency anaemia in infants presenting to their general practitioner in a socially deprived, ethnically mixed suburb., Methods: A total of 43 infants between 6 and 36 months of age were tested for iron deficiency anaemia. The blood tests were collected opportunistically over a 10 month period. Infants with other than trivial illness were excluded. Parents of infants with evidence of iron deficiency were offered dietary counselling, and infants with iron deficiency anaemia were treated with oral iron therapy. Follow up blood tests for iron deficient infants were performed after approximately three months of treatment with oral iron therapy., Results: 42% (18) of infants tested were Pacific Island, 35% (15) were Maori, 16% (7) were European and 7% (3) belonged to other ethnic groups. 23.2% (10) of those tested had iron deficiency anaemia (haemoglobin less than 110 g/L and mean cell volume less than 70 fL). Six of the 10 were followed up and all six found to have improved haematological indices following oral iron therapy., Conclusion: Given the known adverse effects of iron deficiency anaemia in infancy primary health care providers in socially disadvantaged areas should consider screening all infants for iron deficiency anaemia.

Using a "single breath" method, diffusing lung capacity (DLCO) and unit DLCO (KCO) were measured in 19 patients with chronic sideropenic anemia and 19 healthy women who were without any clinical or radiologic evidence suggestive of cardiorespiratory disease. Anemic patients, compared to the control group, had significantly reduced DLCO (% predicted) and KCO (% predicted) (p < 0.01). Each 10 g/L hemoglobin (Hb) reduction below a normal value of 136 g/L corresponded to 2% DLCO% and 3% KCO% reductions. For all examinees, where the range of Hb was from 50 to 150 g/L, a significant positive low linear correlation was noted between DLCO% and HB (r = 0.31; p = 0.049) and KCO% and Hb (r = 0.43; p = 0.005). Analyzing only anemic patients, where the range of Hb was from 50 to 109 g/L, no significant correlation was found between Hb and DLCO% or KCO%. Therefore, in patients with chronic sideropenic anemia DLCO is lowered less then expected, so one should not adjust measured DLCO or KCO values to standard Hb concentration, because probably various pathophysiological compensatory mechanisms affect DLCO components in unknown manner, changing the relationship between Hb and DLCO.

Iron-deficiency anaemia in man may be associated with dry mouth symptoms, such as atrophic glossitis and 'burning mouth', and a low serum iron concentration or iron-deficiency anaemia with aphthous stomatitis or non-ulcerative conditions of the oral mucosa. This study was made on one group of growing rats and another group of adult rats. The iron-deprived rats in both groups gained less weight than control rats. Saliva secretion rate was significantly lower in growing, but not in adult, iron-deprived rats than in the corresponding control groups. The activity of salivary peroxidase was significantly lower in both growing and adult rats with iron-deficiency anaemia than in their control groups. The conclusion is that iron-deficiency anaemia in the rat impairs the protection provided by the salivary peroxidase system, e.g. to hydrogen peroxide, and that saliva secretion rate may be reduced.

To determine the effects of an 8-wk dietary iron supplementation (100 mg.d-1) on low plasma ferritin concentration (< 20 ng.ml-1) and endurance, 20 active women (19-35 yr) were studied while performing a VO2max test and an endurance test (80% VO2max) on a cycle ergometer. Subjects were randomly placed in an iron supplement (IG) or a placebo group (PG) using a double-blind method. After treatment in the IG, ferritin levels were higher (22.5 +/- 3.4 vs 14.3 +/- 2.2 ng.ml-1; P < 0.05), Hb increased (12.8 +/- 0.4 to 14.1 +/- 0.2 g.dl-1; P < 0.05), and TIBC decreased (366.2 +/- 24.8 to 293.8 +/- 14.0 micrograms.dl-1; P < 0.05). Also after treatment the IG's VO2max was significantly greater (P < 0.05) than the PG value and their postendurance blood lactate decreased (5.03 +/- 0.44 to 3.85 +/- 0.6 mM.l-1; P < 0.05). Endurance time to exhaustion increased 38% (37.28 +/- 5.03 to 51.4 +/- 7.45 min) following iron treatment; however, this change was not statistically significant. The results suggest that this level of iron supplementation can reverse mild anemia, increase VO2max, and reduce blood lactate concentration after submaximal exercise.

The effect of treatment with recombinant human erythropoietin on skeletal muscle was investigated in 11 anemic transfusion-dependent patients on the hospital hemodialysis program. There were no significant changes in anthropomorphic measurements during the study, but the maximum voluntary contraction increased significantly for each muscle group studied (pre-erythropoietin and post-erythropoietin values, respectively, were as follows: biceps, median 170 N [range, 83 to 220 N] v 189 N [range, 89 to 245 N]; triceps, 88 N [range, 59 to 167 N] v 106 N [range, 95 to 185 N]; deltoid, 168 N [range, 78 to 247 N] v 193 N [range, 93 to 290 N]; and quadriceps, 202 N [range, 165 to 300 N] v 265 N [range, 185 to 335 N]; P < 0.05). There were no significant changes in muscle strength in a control group of regular hemodialysis patients. Programmed electrical stimulation of the quadriceps following erythropoietin treatment resulted in both a greater force generated and a longer duration of contraction. Following cessation of the electrical stimulus the relaxation rate for the type II fibers was quicker following erythropoietin therapy. This suggests that some of the benefit observed in physical well-being following correction of the anemia of chronic renal failure with erythropoietin is due to an improvement in voluntary skeletal muscle function.

Background: Malabsorption of oraliron is rare, and more frequently suspected than proved. It could be due to prolonged iron deficiency., Case Reports: Case no. 1: A boy was admitted at the age of 5 months for recurrent bronchitis. His hemoglobin was 8.2 g/dl, mean corpuscular volume (MCV) 60 micron3, mean corpuscular hemoglobin (MCH) 15 ng and mean corpuscular hemoglobin concentration (MCHC) 25 gHb/dl. The serum iron was 1 microgram/dl, iron binding capacity (IBC) was 284 micrograms/dl and ferritin was 14.9 ng/ml. Dietary iron was inadequate. The patient was given ferrous sulfate but iron deficiency persisted at the ages of 11 months and 3 years, probably due to poor compliance. Similar hematologic data (Hb: 6.4 g/dl, MCV 55 micrograms/m3, MCH 13.9 ng, MCHC 24 gHb/dl) were found at the age of 9 years. The patient was then given ferrous sulfate orally as test but the serum iron levels were unchanged during the 4 hours following ingestion. A parenteral iron preparation (iron-dextran, 500 mg) improved the hematologic data. 6 months later, a new oral test with ferrous sulfate improved the serum iron level. Case no. 2: A boy with complex congenital cardiopathy was operated on in the neonatal period and given oral iron at the age of 9 months because of anemia with microcytosis and hypochromia. This anemia was still present at 17 months and was associated with normal or high serum ferritin. Electrophoresis of hemoglobin was normal. At the age of 4 yr 5 mo, Hb was 9.7 g/dl, MCV 62.8 micrograms/m3, MCH 18.4 ng, iron 16 micrograms/dl and ferritin 94.1 ng/ml. An oral test with ferrous sulfate failed to increase the serum iron. The patient was then given parenteral iron-dextran without benefit, and a second oral test remained ineffective. After a second course of parenteral iron-dextran, Hb was 11.5 g/dl, MCV 74.1 micrograms/m3, MCH 23.7 ng while the serum iron remained low (23 micrograms/dl) and ferritin increased to 587 ng/ml. A third oral test with ferrous sulfate was still ineffective, as was a test using 4 mg/kg iron., Conclusion: The first patient suffered from iron malabsorption, presumably due to iron deficiency. The second patient could have abnormal metabolism and/or abnormal ferritin.

Treadmill experiments were performed with calves fed milkreplacer (MR) containing 8, 18, 52, or 86 mg of iron (Fe)/kg during the fattening period. Calves walked at 1 m/s for 10 min and then recovered for 15 min. Calves fed 8 and 18 mg of Fe/kg of MR developed severe hypoferraemia and anaemia whereas plasma (PFe) and haemoglobin (Hb) concentration, erythrocyte number (EC) and packed cell volume (PCV) in calves fed 52 and 86 mg of Fe/kg of MR were normal. PFe did not change, whereas Hb, EC, PCV, and blood lactate, heart rate (HR), respiratory rate (RR), respiratory minute volume (VE), fractional oxygen extraction rate (FO2) and O2 consumption (VO2) rapidly increased during walking, and then decreased during recovery. Hb, EC, PCV, partial O2 pressure of blood, FO2, and VO2 were lower, whereas HR, RR, respiratory exchange rate (RER) and blood lactate were higher in calves fed lowest as compared with those fed highest amounts of Fe, while these traits usually were intermediate in other groups. Calves fed 8 mg of Fe/kg of MR were in addition iv injected with FeOH for 3 d before walking. PFe, but not Hb, EC, and PCV, was drastically rised by FeOH. During walking, merely VO2 was improved, but only slightly. In conclusion, adjustments in calves with severe Fe deficiency anaemia were markedly impaired, and barely improved by acute elevation of PFe.

Inflammatory low iron is the second cause, after true iron deficiency, of acquired anaemia. It is mainly due to insufficient erythropoiesis resulting from inhibition of the erythroid progenitor and to disturbances in the synthesis and action of erythropoietin. These changes seem to be dependent on factors, such as TNF-alpha, interleukin-1 and interferon-gamma, which are released in inflammatory processes. Alterations in iron metabolism seem to be secondary, but also partly provoked by the same inhibitory agents. All these anaemias share a common character, i.e. lowering of serum iron level without increase of transferrin level, while plasma ferritin level is within normal limits. In addition to symptomatic therapy by red cell transfusions, numerous trials have shown that recombinant erythropoietin is effective in the treatment of the anaemia that accompanies cancers, chronic inflammatory and rheumatic diseases and of the anaemia provoked by HIV infection.

Iron deficiency anaemia is characterized by the conjunction of a microcytic, typically are generative anaemia and a biochemical syndrome in which sideropoenia is associated with transferrin increase. It is usually due to a chronic exsudative gastrointestinal or gynaecological bleeding. Diagnosing the mechanism of anaemia is easy in most cases, but difficulties arise from association with a pathology, such as chronic inflammatory syndrome, disturbing the haematological or biochemical data. The prognosis of iron deficiency anaemia depends on its cause. Treatment is aetiological (the cause of chronic bleeding is suppressed) and symptomatic (the body's iron reserves are quickly restored).

We performed euglycemic hyperinsulinemic glucose clamps at insulin infusion rates of 1.9, 4.0, 9.3, and 19.3 mU.kg-1 x min-1 in rats with varying severities of iron deficiency anemia (IDA; mean hemoglobin concentrations of 59, 79, 107, and 137 g/l) to assess the effect of IDA on insulin sensitivity and responsiveness. Glucose appearance and disappearance (Rd) rates were determined using a primed continuous infusion of [3-3H]glucose. Basal plasma glucose and insulin concentrations were similar between the IDA and control rats. Basal hepatic glucose production was significantly (P = 0.0001) elevated in the two most anemic groups (13.6 +/- 2.4 and 12.6 +/- 3.1 vs. 10.6 +/- 2.2 and 10.2 +/- 2.0 mg.kg-1 x min-1). A significant upward shift in the insulin dose-response curves for Rd indicated an increase in peripheral insulin responsiveness in the two most anemic groups while a slight leftward shift was suggestive of an increase in insulin sensitivity in all three anemic groups. Hepatic insulin sensitivity and responsiveness were unaffected by IDA. We conclude that increased glucose utilization rates in IDA rats are due primarily to an increase in peripheral insulin responsiveness.

Iron-deficient anaemic infants perform worse in tests of mental and motor development than do iron-sufficient infants of a comparable age. A randomised, double-blind trial was done to monitor the effects of iron supplementation on performance in the Bayley scales of mental and motor development among 12-18-month-old infants in Indonesia. Iron-deficient anaemic infants (n = 50) were assigned randomly to receive dietary ferrous sulphate or placebo for 4 month. Similar treatment randomisation was done among nonanaemic iron-deficient (n = 29) and iron-sufficient (n = 47) infants. Before intervention, the mean mental and motor scores of the iron-deficient anaemic infants were significantly (p < 0.01) lower than those of the nonanaemic iron-deficient and iron-sufficient classes. After intervention, developmental delays were reversed among iron-deficient anaemic infants who had received iron but they remained the same among placebo-treated iron-deficient anaemic infants. Neither ferrous sulphate nor placebo had significant effects on the scores of the other two iron-status classes. The poor performance of 12-18-month-old iron-deficient anaemic infants in the Bayley scales of mental and motor development can be improved to the level of performance of iron-sufficient infants by treatment with ferrous sulphate.

In experiment on Wistar rats the effect of immunomodulators on hemopoiesis in cases of iron deficiency anemia under conditions of ferrotherapy was studied. Tactivine was shown to induce activation of granulocytopoiesis in combination with erythropoiesis inhibition. Sodium nucleinate led to some stimulation of erythrone and weak inhibition of leukopoiesis. Levamisole showed inhibitory effect on hemopoietic tissue. The data obtained are to be taken into account in immunocorrection of hemopoiesis disorders.

In a six year period, 38 patients who had an average packed cell volume of 17.9% (range 14-25%) were treated surgically and their anaemia was corrected with oral haematinics post-operatively. Twenty one of the patients had emergency while 17 had elective surgical procedures under spinal (N = 30), ketamine hydrochloride (N = 6) and local infiltrating (N = 2) anaesthesia. All the wounds healed by primary intention and no wound complication was observed after a mean follow-up period of three years. Headache following spinal anaesthesia occurred in 6 patients and was the only significant post-operative complication detected. We conclude that severe anaemia alone does not retard wound healing in man.

Iron deficiency is usually included among the causes of acquired dyserythropoiesis. This concept was derived mainly from light microscopic studies. To reassess such a notion at ultrastructural level, a transmission electron microscopic evaluation of bone marrow was performed in seven patients with iron-deficiency anemia. In contrast to the widely accepted concept, derived from light microscopic studies, only a small proportion (2-4%, not different from controls) of erythroblasts displayed some of the features of nuclear dyserythropoiesis. On the contrary, when examining the cytoplasm, we found a significantly increased number of void ropheocytotic vesicles in the majority of late erythroblasts as compared to controls (P less than 0.001). This feature may be considered as an ultrastructural marker of iron deficiency and is consistent with the present knowledge on transferrin-mediated delivery of iron to the cell.

1) Athletes tend to have lower hemoglobin concentrations than sedentary counterparts. This has been called sports anemia, a misnomer. 2) Sports anemia is a false anemia and a beneficial adaptation to aerobic exercise, caused by an expanded plasma volume that dilutes red blood cells. 3) Athletes, however, can also develop true anemia, most commonly caused by iron deficiency. True anemia curbs athletic performance, but nonanemic iron deficiency does not. 4) Iron supplements are useful for women endurance athletes who repeatedly develop iron deficiency anemia despite dietary advice. 5) Some endurance athletes today are blood doping by abusing recombinant human erythropoietin (rEPO). They risk dying to win.

Iron status, iron absorption, and intestinal blood loss were studied in 199 children undergoing diagnostic evaluation for suspected malabsorption. Evaluation of iron status included hematological indices, serum ferritin, and transferrin saturation. Iron absorption was assessed by the increment of serum iron after an oral iron load. Iron deficiency was common among patients affected by malabsorptive states, such as celiac disease (84%), cow's milk intolerance (76%), Crohn's disease (72%), and giardiasis (64%), whereas it was less common among patients with postinfectious enteritis (41%) and chronic nonspecific diarrhea (11%). Intestinal blood loss was seen only in patients with Crohn's disease and cow's milk intolerance, irrespective of iron nutritional status. On the other hand, iron malabsorption was very common, affecting 85-95% of the iron-deficient patients in all diagnostic groups, except in chronic nonspecific diarrhea. Iron malabsorption was less common among patients with adequate iron nutritional status than in those with iron deficiency. Iron malabsorption appears to play a major role in the pathogenesis of iron deficiency in patients with malabsorption. The iron absorption test shows greater sensitivity as a screening test for upper intestinal malabsorption than the D-xylose absorption test.

The lipid structure and Ca2+ permeability of red blood cell, hepatocyte and cardiomyocyte membranes were determined while investigating the effect of hypoxia caused by iron deficiency anemia upon the structural and functional state of biological membranes. The lipid composition and barrier characteristics of membranes change under conditions of hypoxia caused by experimental iron deficiency anemia. Quantitative changes in the cell membrane lipids may be considered as an important molecular mechanism of Ca2+ transport disorder in membranes, increase of Ca2+ permeability producing its surplus in the cells and subsequent metabolic homeostatic disturbances.

Pathophysiological and therapeutic properties of anemia in rats with adjuvant-induced arthritis (AA) were investigated. Both anemia and chronic inflammation were induced in rats by a single injection of Freund's complete adjuvant. This study confirmed other earlier data that these anemic rats with AA had reduced serum iron levels and that the anemia was characterized as mild, non-progressive, hypochromic, microcytic. In addition, our studies showed that these anemic rats had slightly but significantly enhanced erythropoietin titers, but not renal failure; there was no significant difference in blood urea nitrogen and creatinine levels in anemic and normal groups. The anemia in rats with AA was improved by recombinant human erythropoietin (r-HuEPO) at 30 and 100 U/kg/day, given i.v. for 5 days. In contrast, iron-chondroitin-sulfate colloid (10 mg/kg/day, i.v. for 5 days) failed to improve the anemia and to enhance the effects of r-HuEPO. These data suggest that anemia in rats with adjuvant-induced arthritis is distinguished, pathophysiologically and therapeutically, from iron deficiency anemia, hemolytic anemia, and renal anemia.

Background: Iron-deficiency anemia has been associated with lowered scores on tests of mental and motor development in infancy. However, the long-term developmental outcome of infants with iron deficiency is unknown, because developmental tests in infancy do not predict later intellectual functioning., Methods: This study is a follow-up evaluation of a group of Costa Rican children whose iron status and treatment were documented in infancy. Eighty-five percent (163) of the 191 children in the original group underwent comprehensive clinical, nutritional, and psychoeducational assessments at five years of age. The developmental test battery consisted of the Wechsler Preschool and Primary Scale of Intelligence, the Spanish version of the Woodcock-Johnson Psycho-Educational Battery, the Beery Developmental Test of Visual-Motor Integration, the Goodenough-Harris Draw-a-Man Test, and the Bruininks-Oseretsky Test of Motor Proficiency., Results: All the children had excellent hematologic status and growth at five years of age. However, children who had moderately severe iron-deficiency anemia as infants, with hemoglobin levels less than or equal to 100 g per liter, had lower scores on tests of mental and motor functioning at school entry than the rest of the children. Although these children also came from less socioeconomically advantaged homes, their test scores remained significantly lower than those of the other children after we controlled for a comprehensive set of background factors. For example, the mean (+/- SD) adjusted Woodcock-Johnson preschool cluster score for the children who had moderate anemia in infancy (n = 30) was 448.6 +/- 9.7, as compared with 452.9 +/- 9.2 for the rest of the children (n = 133) (P less than 0.01); the adjusted visual-motor integration score was 5.9 +/- 2.1, as compared with 6.7 +/- 2.3 (P less than 0.05)., Conclusions: Children who have iron-deficiency anemia in infancy are at risk for long-lasting developmental disadvantage as compared with their peers with better iron status.

Resting and bicycle ergometric ECGs were examined in 159 patients with iron deficiency anemia, including 100 treated with iron-containing drugs. ST segment depression in the patients undergoing exercise was regarded as a sign of silent myocardial ischemia which is common in anemic patients, its detection rate increases as the disease progresses. In patients with iron deficiency anemia, silent myocardial ischemia results in a substantial decrease of threshold intensity, has a negative effect on cardiac output both at rest and during exercise, and significantly slows down the recovery of cardiac performance during therapy. This should be borne in mind while solving problems in medial labour examinations and making rehabilitative measures in patients with the above abnormality.

Iron-deficiency anemia (IDA) in rats is attended by secondary cellular immunodeficiency. The authors studied the importance of lymphocyte dysfunction in the pathogenesis of hematological disorders in rats with IDA. Transplantation of lymphocytes from intact donors subjected to hypoxia to syngeneic recipients led to stimulation of erythropoiesis in them. The effect of "iron deficiency' cells was less manifest. It was established that the hematological disorders in IDA are lymphocyte-determined. This was also demonstrated in experiments on rats with IDA and changed functional condition of the lymphoid tissue.

There is clear clinical evidence that tumours in anaemic patients are difficult to control with radiotherapy. We have studied the radiosensitivity of two transplantable mouse tumours, the SCCVII/St carcinoma and the KHT sarcoma in hosts made anaemic either with an iron poor diet or as a result of tumour growth. The haemoglobin level and haematocrits of mice on the low iron diet fell to about 60% of normal within 11 weeks. The number of clonogenic cells after a single X-ray dose of 20 Gy was slightly lower (P less than 0.05) in the anaemic animals (2.3 X 10(4) g-1) than in controls (5.2 X 10(4) g-1) though there was no significant difference in the surviving fractions. Mice bearing KHT tumours became anaemic with haematocrits falling to 65% of normal as their tumours grew from 300-1200 mg. A second 'test' tumour was implanted one week after the first 'anaemia-inducing' tumour so that estimates of radiosensitivity could all be carried out on tumours within the same size range (150-300 mg). Radiosensitivity was significantly greater in the most anaemic hosts with 2.2 X 10(4) cells g-1 surviving a dose of 20 Gy compared with 6.7 x 10(4) g-1 in controls (P less than 0.01). These results are consistent with most published data for mouse tumours though not for many human tumours.