By Manfred Wick, Wulf Pinggera, Paul Lehmann
Iron is vital for many varieties of lifestyles, together with people. nevertheless, iron is usually possibly poisonous. accordingly, the keep watch over of iron metabolism and upkeep of iron hemostasis is an an important a part of many facets of human future health and disorder. Iron deficiency anemia is among the commonest illnesses around the world, yet there also are anemias linked to continual ailments, and different obtained or hereditary defects. realizing the regulate of iron metabolism is additionally vital for figuring out illnesses of iron overload, like hemochromatosis. This e-book is designed for physicians, scientific lab group of workers and scientific scholars. It provides an summary concerning the rules of rules of iron metabolism and erythropoiesis. moreover, some of the disturbances of iron metabolism and the linked medical findings are defined. specified concentration lies at the differential analysis of the issues, and the techniques of treatment. ultimately, a accomplished time table of exams is incorporated to be had for the selection of iron metabolism-related parameters in serum/plasma and blood, with indication of methodologies utilized and reference levels.
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Extra info for Clinical Aspects and Laboratory. Iron Metabolism, Anemias, 6th Edition
Renal Anemias Particular attention should be paid to iron metabolism in patients with renal anemia. v. administration of iron, has replaced transfusions which used to be performed routinely, and has therefore revolutionized therapy. 33 Transfusions, which previously were performed on a regular basis and the concomitant disturbance of iron utilization due to erythropoietin deficiency almost invariably led to increasing iron overload and its associated consequences. The treatment of disturbances of iron metabolism in dialysis patients is now fundamentally different since the introduction of EPO therapy, however.
Fig. 12: Molecular structure of erythropoietin Fundamentals Erythropoiesis Fundamentals 20 Erythropoiesis EPO production increases in response to tissue hypoxia, low arterial PO2, and increased oxygen affinity (HbF) of red blood cells. The hypoxic induction of EPO production is regulated by a negative feedback mechanism at the transcriptional level, which involves binding of HIF-1 (Hypoxia-Inducible Factor-1). HIF-1 acts as an oxygen sensor, which ensures that EPO production is increased when oxygen supply to the tissue is low and the demand for new erythrocytes is high, while EPO production is shut down when red blood cell numbers/and or tissue oxygen supply returns to normal .
By contrast, folic acid deficiency arises mainly as a result of unbalanced diet and reduced storage in liver damage, especially in connection with alcoholism. Other important causes are malabsorption in intestinal diseases and inhibition of the folic acid synthesis of intestinal bacteria by antibacterial or cytotoxic chemotherapy with folic acid antagonists. The intracellular bioavailability of the active form tetrahydrofolic acid also depends on an adequate supply of vitamin C (reduction) and in particular of vitamin B12 (intracellular uptake).