ron Anemia with Paraoical levations of ron Storage an etabolic ron Utiliation Challenges


by: Aaron Root, DC, DACNB, FACFN, Dipl.Ac. Nutrition Institute - University of Bridgeport, Bridgeport, CT


Author Note


This paper describes iron anemia coexisting with para- doxical syndromes of iron overload as a consequence of altered or impaired bioavailability of iron. Iron anemia frequently occurs in the presence of iron mis-utilization syndromes or iron overload as these clinical and sub-clinical conditions exist as a continuum instead of as separate or distinct conditions. The broad, yet vague, diagnostic term “anemia of chronic disease” best categorizes the complexity of events that lead to paradoxical disorders related to iron metabolism. Nutritional biochemistry applications contribute a pivotal role in identifying and prioritizing diagnostic criteria for improving accuracy and corrective prioritization of therapeutic interventions that transcend the complexity and variability of these syndromes. Once understood, earlier and more successful conservative interventions may be achieved.


Abstract


Characteristics of iron anemia are frequently superimposed on those of iron overload, creating a diagnostic and therapeutic challenge. Disorders that promote an anemic state exist in a reciprocal “cause and effect” continuum of disorders that promote an iron overload state.14


not uncommon to encounter a clinical situation where symptoms, clinical signs, and laboratory chemistry markers indicate an iron anemia, yet also imply a situation of iron overload. Key considerations involve attention to hepatic and renal pathologies, alimentary and lifestyle inventories, toxic and immunological burdens, and genetic predispositions that may amplify or promote an iron metabolism dysfunction. Greater than 10% of the aging population at 65 years of age or older and greater than 20% at 85 and older have IDA (Iron-deciency anemia).16


Anemia of chronic disease is thought to account for nearly a nearly a fth of anemia cases (19.7%) in older adults (US data).15


and relevant dietary and micronutrient interventions involving the addition or cessation of relevant foods and micronutrient(s) may be employed to resolve or improve


28


a prevalence of 1 in 200 for hereditary hemochromatosis. The prevalence of CKD (chronic kidney disease) is reported to be 7.2% to 35.8% depending on age.21


Specic American Diabetes Association data reports It is


the condition(s).


Keywords: IDA, CKD, ACD, hepcidin, iron overload, anemia of chronic disease, nutritional anemias, micro- nutrients.


Iron deciency anemia is the most common micronutrient deciency worldwide.2


only one of several factors and micronutrients involved in manifestations of micronutrient-related anemia which include; vitamin B6, vitamin B12, folate, copper, zinc, vitamin C, proteins, and several other cofactors. Situational anemias related to micro-bleeding from gastrointestinal disease, gastrointestinal malabsorption syndromes, inammatory syndromes, menstruation, pregnancy, and those related to bleeding from trauma can also occur.


autoimmune anemias also exist within the context of the denition. Anemia may manifest as reduced blood cell formation including red blood cells, platelets, white blood cells, as well as the hemoglobin concentration and maturation of blood cells.1,3


Iron anemia exists worldwide, whether from alimentary unavailability, or the presence of dietary availability of iron. The aging population is particularly vulnerable to IDA, and diagnosis has frequently been overlooked and trivialized as a normal part of aging.


The condition has many manifestations and causes, due to the variability and superimposed dysfunction in multiple organ systems, its metabolic utilization and co-utilization with other micronutrients, and its interdependent cofactor and micronutrient relationships in enzymatic reactions.1,2,5 In this case, poor binding, transport, or utilization of alimentary iron (or a combination of these physiological conditions) may deprive the bloodstream and tissues of bioavailable iron. The sensitivity and integrity of the signaling of the iron-regulating protein, hepcidin, plays a key role in how iron is managed.1,2,11,13,20,23


(Fig. 3) Hereditary and genetic anemias and


a term for a disease entity, and more a term for a symptom of many different and divergent disorders that may have a varied convergent set of symptoms. Within the context of the very broad context of “anemias,” there exist at least 12 different categories, and at least 38 different subtypes of anemia organized within those categories.12


Iron is


when individual hemoglobin concentrations fall below two standard deviations of the distribution mean for hemoglobin in a healthy population of the same gender and age and living at the same altitude.”1,3


Therefore, it is less By denition, “anemia is present


Iron overload disorders can occur from metabolic conditions or situations that impair the gastrointestinal absorption and transport, transmembrane and hepatic binding and transport, excessive iron supplementation, or copper deciency or utilization problem.1,2,8,20


and involves impaired HFE gene regulation of intestinal absorption of iron. Type 2 HH is rare, and involves mutations impairing hemojuvelin or hepcidin function.2 Type 3 HH involves impaired transferrin receptor 2 gene,


also occur as a hereditary genetic disorder known as HH (Hereditary Hemochromatosis), of which there are four known types. There are at least 20 known subtypes of iron overload subdivided within the categories of primary and secondary types.20


HH Type 1 is the most common,


THE ORIGINAL INTERNIST MARCH 2017 (Continued on next page)


It can


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