green sickness

is a form of anemia named for the greenish tinge of the skin of a patient. Its symptoms include lack of energy, shortness of breath, dyspepsia, headaches, loss of appetite and amenorrhoea.

Today this disease is diagnosed as hypochromic anemia

In 1554, German physician Johannes Lange

Chlorosis

iron deficiency in plants

Iron deficiency anemia was discovered in 1968. At that time, neither ferritin nor transferrin in the blood could be measured, and certainly not soluble transferrin receptors

Iron Deficiency

Middle East-Africa

- iron deficiency is a serious problem

- one-third to one-half of women suffer from anemia

- most of the anemia is due to iron deficiency

IRON DEFECIANCY in Females

Age Group Industrialized Countries

Non Industrialized Countries

Children 0 - 4 years 20.1% 39.0%

Children 5 - 14 years

5.9% 48.1%

Pregnant women 22.7% 52.0%

Women 15 - 59 years

10.3% 42.3%

Men 15 - 59 years 04.3% 30.0%

Elderly > 60 years 12.0% 45.2%

Anemia Prevalence (WHO)

© WORLD HEALTH ORGANIZATION, 2001

www.iron-code.net

Me and Rolls-Royce are same,

We both need FUEL to move.

Forms Storage iron (Ferritin)

Functioning iron

Heme iron (Hemoglobin)

Occurrence iron storage other tissues hemoglobin bone marrow

Functions storage 179 iron-dependent functions

blood formation(the most important iron-dependent function)

Distribution 20% 10% 70%

Deficiency 1st reduction 2nd reduction 3rd reduction

The Underestimated Element 2009The Rediscovery of the Iron Deficiency Syndrome

Dr. med. Beat Stephan Schaub

Physical performance

IDS

IDA

The World Health Organization defines anemia as hemoglobin (Hb) levels

< 13 g/dL in men and postmenopausal women

< 12 g/dL in premenopausal women

Early stageIron deficiency syndrome

IDS

FatigueDifficulty concentration

Depressed moodSleeping disturbance

Neck tensionsHeadacheDizziness

Loss of hair

Early stageIron deficiency syndrome

IDS

FatigueDifficulty concentration

Depressed moodSleeping disturbance

Neck tensionsHeadacheDizziness

Loss of hair

Late stageIron deficiency anemia

IDA

Pallor (pale skin)General malaise

Muscular weaknessDyspnea

PalpitationTachycardia

Low blood pressure

Iron deficiency stages

The Underestimated Element 2009The Rediscovery of the Iron Deficiency Syndrome

No

Neck tensions

Depressed mood Sever HeadacheMigrane

Loss of hairSleeping disturbance

Immunity affection

What a body needs iron for

Red blood cell formation

70 % of body iron

Myoglobin formation

Myoglobin occurs in the cells of the heart muscle and the skeletal muscles

What a body needs iron for

Hormone formation

formation of hormones can only occur if a biochemical impulse for their production is sent. This requires enzymes - substances, also known as catalysts these enzymes need iron to do their job

Serotonin

Dopamine

an endorphin, is also often referred to as the “happy hormone.”

Like serotonin, dopamine is called a “happy hormone”

dopamine makes it possible for a person to recognize relevant stimuli, i.e., those that are meaningful to him, and ignore unimportant ones

Melatonin

DSIP (Delta Sleep Inducing Peptide)

regulates the functioning of what is known as our inner clock

produces the deep sleep, an important sleep phase that is responsible for the quality of our nightly recovery.

Cortisol

controls all of the protein, sugar and fat metabolisms

As a stress hormone, it is simultaneously responsible for our body to adapt to special stresses with appropriate reactions

Energy production

Each body cell contains a large number of mitochondria We consider them our “power plants” and they use adenosine triphosphate (ATP) to produce the necessary chemical cell energy It is the iron-sulfur molecules, which are the central constituents in the cascade of chemical reactions that results in energy being released in the cells

Eicosanoid formation

Eicosanoids are our organism’s iron-containing signaling molecules, which directly influence many of our bodily functions

a) Effect on smooth muscle tension

b) Influence on the stomach

c) Effect on the immune system

Eicosanoids influence the state of tension of the smooth muscles. Depending on the impulse that the smooth muscle cells are exposed to, they change from a state of tension to a state of relaxation and vice versa These signaling molecules thereby have a direct effect on important bodily functions, such as

blood pressure regulationbreathingintestinal and uterine activities.

a) Effect on smooth muscle tension:

b) Influence on the stomach: In the stomach, an equilibrium typically exists between the aggressive hydrochloric acid needed for digestion and the mucous membrane, a layer of cells protecting the stomach walls.

Here, the iron-containing eicosanoids are co-responsible for both the acid production and for an adequate quality of the protective layer.

c) Effect on the immune system:

The eicosanoids also include leukotrienes.

Those are small acid particles in the white blood cells,

which are

1.effective in connection with allergic and inflammatory reactions.

2.It is also the function of leukotrienes to “attract” the body’s antibodies to the site of an infection.

Basic tissue formation

Iron is co-responsible for the formation and regeneration of our organism’s basic tissues. These are known to include bone, cartilage, skin, connective tissue, mucous membranes, hair and nails. In these building processes, protein chains are converted to stable fibers by a biochemical process known as hydroxylation. Iron is indispensable for this process as well.

From menarche to Menopause5-7 years of continuous bleeding

General facts

Menstrual blood loss Ranging from 10-250ml4-100 mg of iron per period

A women loses about 500 mgOf iron with each pregnancy

General facts

US Pharmacist 2007M.Saljoughian,PharmD,PhDAlta Bates Summit Medical Center,Berkely,California

Even if you consume a balanced diet, you may not be getting adequate iron if you are in one of these groups:

• Premenopausal women especially those who bleed heavily during menstruation, since blood losses increase iron needs.

• Dieters, especially premenopausal women. The less you eat, the less likely you are to get enough iron.

Faint is not a description of color 

Faint is a description of LIFE 

A feeling that you do not need

Unfocused

Causes of iron deficiency

-Iron deficiency occurs if the equilibrium between iron needs & input is not reached due to

Increased demands

Insufficient intake

Malabsorption

Increased losses

Phlebotomy

Hemorrhage

IRON Characters No ManufactureNo Metabolism

Recycling

Papayannopoulou T, et al. In: Hoffman R, et al., ed. Hematology: Basic Principles and Practice. 4th ed. 2005;267-288.

SCF, GM-CSF, IL-3

SCF, IL-1, IL-3, IL-6, IL-11

PluripotentStem Cell

Burst-Forming Unit-Erythroid Cells (BFU-E)

Colony-FormingUnit-ErythroidCells (CFU-E)

Reticulocytes RBCsErythro-blasts

Proerythro-blasts

About 8 Days

IronErythropoietin

Erythropoiesis in CKDErythropoiesis

Evaluate other causes of anemia (bleeding)

Obtain CBC Hgb - RBCs count - MCV- MCH

Assess for adequate iron stores Ferritin 50 ng/ml or more TS 20% or more

< 10 ng/ml 50 ng/ml 100 ng/ml > 100 ng/ml invalid

Step 1 Insert the TEST CARD

Step 2 Apply the SAMPLE

Step 3 Read the RESULT in 2 min

Restore the iron needed for Erythropoiesis & other functions

Resolution of sever anemia with target Hb 12 g/dl

Reduce need for transfusion and or hospitalization

Enhance quality of life

Initiate therapy with IRON Each 1 gm Hgb require 150 mg of bioavilable iron Calculate iron stors by ferritin test Iron stores should be at least 500 mg

Initiate therapy with Erythropoietin 50 IU/Kg/W check Hgb- iron monthly Till goals of therapy achieved

Calculate iron needs for one year a head

Check Anemia early and often

The Hemoglobin Sweet Spot

11 12 139 Hb g/dL

Risk

100%

50%

EfficientAbsorption 23 times greater than iron saltsAbsorption is through the heme receptorsAong the GIT

CompliantTaken with mealsTaken with tea &coffeeNot affected by Gastric acidity as it Does not need to change to Ferrous-Ferric- Ferrous

QualityMade in Sweden

ConstipationCrampingHeartburnNausea

Heme Iron Polypeptide

Absorbed as ferrous

Absorbed from receptors along the GIT

Iron is Coated with the heme molecule in GIT

No constipation

Iron salts

Absorbed after changing from Ferric Ferrous Ferrous

Absorbed from receptors localized at the duodenum

Iron is free in GIT in huge quantity

Usually associated with constipation

Not affected by gastric acidity Affected by gastric acidity

Higher absorption Limited absorption

Heme Iron Polypeptide

Can be taken with food , Tea or Coffee

10 tablet give 60 mg of elemental iron

10 tablets in 5-10 days

No constipation

For a pregnant lady to load iron of 800 mg she will take 134 tablet in 2 month (2 tab/day)

Each 1 gm of hemoglobin need 150 mg of elemental iron = 25 tablet

Can be taken in 13 day

Iron salts

Taken on empty stomach

compared to 60 tablets give 60 mg of elemental iron

60 tablets in 2 month

Usually associated with constipation

For a pregnant lady to load iron of 800 mg she will take 800 tablet in 26 month (1 tab/day)

Each 1 gm of hemoglobin need 150 mg of elemental iron = 150 tablet Can be taken in 5 month

=