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Fig.\t3.2\n\tin\nChapter\t3\n).\tOverhydration\tis\tcaused\tby\tan\tincrease\tin\tcapillary\thydrostatic\tpressure\tor\tcapillary\npermeability,\tor\ta\tdecrease\tin\tcolloid\tosmotic\tpressure.\tIt\toften\tis\tassociated\twith\trenal\tfailure,\nchronic\theart\tfailure,\tcirrhosis\tof\tthe\tliver,\tCushing’s\tsyndrome,\texcess\tuse\tof\tsodium-containing | [
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intravenous\tfluids,\tand\texcessive\tintake\tof\tsodium-containing\tfood\tor\tmedications.\tCharacteristics\ninclude\trapid\tweight\tgain,\tperipheral\tedema,\tdistended\tneck\tveins,\tslow\temptying\tof\tperipheral\nveins,\ta\tbounding\tand\tfull\tpulse,\trales\tin\tthe\tlungs,\tpolyuria,\tascites,\tand\tpleural\teffusion.\tPulmonary\nedema\tmay\toccur\tin\tsevere\tcases. | [
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edema\tmay\toccur\tin\tsevere\tcases.\nLaboratory\tmeasures\tof\thydration\tstatus\tinclude\tserum\tsodium,\tblood\n\turea\tnitrogen\t(elevated\tout\nof\tproportion\tto\tserum\tcreatinine),\tserum\tosmolality,\tand\turine-specific\tgravity.\tAlthough\tthe\nlaboratory\ttests\tare\timportant,\tdecisions\tregarding\thydration\tshould\tonly\tbe\tmade\tonly\tin | [
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] |
conjunction\twith\tother\tinformation\tfrom\tphysical\texamination,\tnutrition-focused\tphysical\nexamination,\tand\tthe\tclinical\tcondition\tof\tthe\tpatient.\tIn\taddition,\tmany\tother\tlaboratories\n\tmay\tbe\naffected\tby\toverhydration\tor\tdehydration,\tand\taccurate\tinterpretation\tof\tlaboratory\tresults\tis\tcritical\nin\tassessing\tpatients\t(see\t\nTable\t5.1\n). | [
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Inflammation\tand\tbiochemical\tassessment\nInflammation\n\tis\ta\tprotective\tresponse\tby\tthe\timmune\tsystem\tto\tinfection,\tacute\tillness,\ttrauma,\ntoxins,\tmany\tchronic\tdiseases,\tand\tphysical\tstress.\tBiochemical\tindices\tare\taffected\tby\tinflammation\nprimarily\n\tby\tredirection\tto\tsynthesis\tof\tacute\tphase\treactants.\tInflammatory\tconditions\ttrigger\tthe | [
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inflammatory\tresponse.\tMoreover,\tthere\tis\ta\tredistribution\tof\talbumin\tto\tthe\tinterstitial\ncompartment,\tresulting\tin\tedema.\tDeclining\tvalues\tof\n\tthe\t\nnegative\tacute-phase\treactants\n\t(i.e.,\nserum\talbumin,\tprealbumin,\tand\ttransferrin)\talso\treflect\tthe\tinflammatory\tprocesses\tand\tseverity\tof | [
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response.\tRefer\tto\t\nChapter\t7\n\tfor\tmore\tinformation\ton\tthe\teffects\tof\tcytokines\ton\torgan\tsystems.\nAs\tthe\tbody\tresponds\tto\tacute\tinflammation,\tTNF-α,\tIL-1β,\tIL-6,\tand\tPGE2\tincrease\tto\ta\tset\nthreshold,\tthen\tIL-6\tand\tPGE2\tinhibit\tTNF-α\tsynthesis\tand\tIL-1β\tsecretion,\tcreating\ta\tnegative | [
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feedback\tcycle.\tHepatic\tsynthesis\tof\tpositive\tacute-phase\treactants\tdiminishes,\tand\tsynthesis\tof\nnegative\tacute-phase\treactants\tincreases.\tAlbumin\tshifts\tfrom\tthe\tinterstitial\tcompartment\tto\tthe\nextravascular\tspace\n\twhere\tit\tcan\tbe\tmeasured\tas\tserum\talbumin.\tAlbumin\tin\tthe\tinterstitial\tspace | [
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cannot\tbe\tmeasured,\ttherefore\talbumin\tis\tnot\ta\treliable\tmarker\tfor\tprotein\tstatus.\tIron\tstores\tshift\nfrom\tferritin\tto\ttransferrin\tand\themoglobin.\nMarkers\tof\tinflammation\nBiochemical\tmarkers\tof\tinflammation\tinclude\tpositive\tacute\tphase\treactants\tand\tnegative\tacute\nphase\treactants.\tIn\tthe\tpresence\tof\tinflammation,\tthe | [
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0.06496607512235641,
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0.028535183519124985,
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0.06235343962907791,
0.05582704767584801,
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0.01050933264195919,
0.09092847257852554,
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-0.030219802632927895,
0.1066574901342392,
-0.029889825731515884,
-0.05906221270561218,
-0.06265817582607269,
0.05299520865082741,
0.05988320708274841,
0.016949614509940147,
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0.09053149074316025,
0.07312129437923431,
0.12200112640857697,
-0.008340390399098396
] |
phase\treactants.\tIn\tthe\tpresence\tof\tinflammation,\tthe\n\thepatic\tsynthesis\tof\tpositive\tacute-phase\nreactants\tis\t\nincreased\n\twhile\tthe\tsynthesis\tof\tthe\tnegative\tacute-phase\treactants\tis\t\ndepressed.\n\tSee\nTable\t5.4\n\tfor\tacute\tphase\treactants.\tAdditional\tmarkers\tof\toxidative\tstress\tand\tinflammation\tcan\tbe\nfound\tin\t\nTable\t5.5\n.\nTABLE\t5.4 | [
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0.0022314018569886684,
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0.04460465535521507,
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0.07898566871881485,
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0.002725039841607213,
0.009241962805390358,
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0.058872636407613754,
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0.009809091687202454,
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0.0009190515265800059,
0.0023343043867498636,
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0.05066503956913948,
0.039918091148138046,
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0.04794754832983017,
0.0006131369154900312,
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0.0936557725071907,
0.021705182269215584,
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0.04976150020956993,
0.07924956828355789,
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0.06491237133741379,
0.03392087668180466,
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0.099062480032444,
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0.06625879555940628,
0.06519138067960739,
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0.009056881070137024,
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0.06341531872749329,
0.09381479024887085,
0.10109303891658783,
-0.037912338972091675
] |
found\tin\t\nTable\t5.5\n.\nTABLE\t5.4\nAcute\tPhase\tReactants\nPositive\tAcute-Phase\tReactants\nNegative\tAcute-Phase\tProteins\nC-reactive\tprotein\nAlbumin\na\n-\n1\n\tantichymotrypsin\nTransferrin\na\n1\n-antitrypsin\nPrealbumin\t(transthyretin)\nHaptoglobins\nRetinol-binding\tprotein\nCeruloplasmin\nSerum\tamyloid\tA\nFibrinogen\nFerritin\nComplement\tand\tcomponents\tC3\tand\tC4 | [
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0.030416399240493774,
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0.06525114178657532,
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1.5656693948640137e-33,
0.07260596007108688,
0.04706249758601189,
-0.014135362580418587,
0.07164689898490906,
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Fibrinogen\nFerritin\nComplement\tand\tcomponents\tC3\tand\tC4\nOrosomucoid\nTABLE\t5.5\nAdvantages\tand\tDisadvantages\tof\tVarious\tBiomarkers\tof\tOxidative\tStress\nBiomarker\nAdvantages\nDisadvantages\nComments\nIsoPs\t(isoprostanes)\nCan\tbe\tdetected\tin\tvarious\tsamples\n(serum,\turine)\tand\thas\tbeen\nshown\tto\tbe\televated\tin\tthe\npresence\tof\ta\trange\tof\tCV\trisk\nfactors | [
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shown\tto\tbe\televated\tin\tthe\npresence\tof\ta\trange\tof\tCV\trisk\nfactors\nCurrent\tmethods\tof\nquantification\tare\nimpractical\tfor\nlarge-scale\nscreening.\nNo\tevidence\nlinking\tthis\nbiomarker\tto\nclinical\noutcomes\tyet.\nF\n2\n-IsoPs\tshow\nmost\tpotential\nMDA\t(mal-\nondialdehyde)\nTechnically\teasy\tto\tquantify\nspectrophotometrically\tusing\nthe\tTBARS\tassay\tELISA\tkits\tto | [
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progression\tof\tCAD\tand\tcarotid\natherosclerosis\tat\t3\tyears\ninfluence\tresults.\nimpact\ton\tthe\npathophysiology\nof\tCVD\nNitrotyrosine\t(3-\nNO2-tyr)\nHuman\tstudies\thave\tdemonstrated\nassociation\twith\tCAD\nindependent\tof\ttraditional\trisk\nfactors\nCirculating\tlevels\nare\tnot\nequivalent\tto\ntissue\tlevels.\nCurrent\tdetection\nmethods\tare\nexpensive\tand\nimpractical. | [
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Current\tdetection\nmethods\tare\nexpensive\tand\nimpractical.\nNitrotyrosine\nformation\ton\nparticular\ncardiovascular\nproteins\thas\ndirect\teffect\ton\nfunction\nS-glutathionylation\nS-glutathionylation\n\tof\tSERCA,\neNOS\tand\tNa\n+\n–K\n+\n\tpump\ndemonstrated\tas\tbiomarkers\tas\nwell\tas\trole\tin\tpathogenesis\nDetection\tof\tS-\nglutathionylation\nprone\tto\nmethodological | [
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Detection\tof\tS-\nglutathionylation\nprone\tto\nmethodological\nartifact\nAccess\tto\ttissue\n(myocardium,\nvasculature),\nwhere\nmodification\noccurs\tpresents\ta\nclinical\tobstacle\nModified\nhemoglobin\ncurrently\tbeing\ninvestigated\tas\nbiomarker\nMyeloperoxidase\n(MPO)\nCommercial\tassays\tavailable.\tAn\nenzyme\tabundant\tin\n\tgranules\tin\ninflammatory\tcells.\tStrong | [
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by\tantioxidant\npharmacotherapy\nhas\tnot\tbeen\nmatched\tby\nreduction\tin\tCVD\nseverity.\nELISAs\tfor\tOxLDL\ndetection\nreadily\tavailable\nROS-induced\nchanges\tto\tgene\nexpression\nThe\texpression\tof\tseveral\tgenes\ninvolved\tin\tregulating\toxidative\nstress\tmay\tbe\n\tmeasured\nsimultaneously\tusing\tmicroarray\ntechnology,\tpotentially\nincreasing\tthe\tpower\tof\tthis\nbiomarker | [
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ELISA\n,\tenzyme-linked\timmunosorbent\tassay;\t\nTBARS\n,\nthiobarbituric\tacid\t(TBA)\treacting\tsubstances;\t\neNOS\n,\tendothelial\tnitric\toxide\tsynthase;\t\nGPX-1\n,\tglutathione\tperoxidase-1,\t\nROS\n,\treactive\toxygen\nspecies;\t\nSERCA\n,\tsarcoplasmic\treticulum\tCa\n2+\n\t-ATPase,\t\nSOD\n,\tsuperoxide\tdismutase. | [
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,\tsarcoplasmic\treticulum\tCa\n2+\n\t-ATPase,\t\nSOD\n,\tsuperoxide\tdismutase.\nAdapted\tfrom\tHo\tE\tet\tal:\tBiological\tmarkers\tof\toxidative\tstress:\n\tapplications\tto\tcardiovascular\tresearch\tand\tpractice,\t\nRedox\tBiology\n\t1:483,\t2013.\nPositive\tacute\tphase\treactants\nC-reactive\tprotein\nC-reactive\tprotein\t(CRP) | [
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C-reactive\tprotein\nC-reactive\tprotein\t(CRP)\n\tis\ta\tnonspecific\tmarker\tof\tinflammation\tthat\tmay\thelp\testimate\tand\nmonitor\tthe\tseverity\tof\tillness.\t\nHigh-sensitivity\tCRP\t(hs-CRP)\n\tis\ta\tmore\tsensitive\tmeasure\tof\nchronic\tinflammation\tseen\tin\tpatients\twith\tatherosclerosis\tand\tother\tchronic\n\tdiseases\t(\nWang\tet\tal,\n2017 | [
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diseases\t(\nWang\tet\tal,\n2017\n).\tAlthough\tthe\texact\tfunction\tof\tCRP\tis\tunclear,\tit\tincreases\tin\tthe\tinitial\tstages\tof\tacute\tstress\n—usually\twithin\t4\tto\t6\thours\tof\tsurgery\tor\tother\ttrauma.\tFurthermore,\tits\tlevel\tcan\tincrease\tas\tmuch\nas\t1000-fold,\tdepending\ton\tthe\tintensity\tof\tthe\tstress\tresponse.\tWhen\tthe\tCRP\tlevel\tbegins\tto | [
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Ferritin\nFerritin\n\tis\ta\tpositive\tacute-phase\tprotein,\tmeaning\tthat\tsynthesis\tof\tferritin\tincreases\tin\tthe\npresence\tof\tinflammation.\tFerritin\tis\tnot\ta\treliable\tindicator\tof\tiron\tstores\tin\tpatients\twith\tacute\ninflammation,\n\turemia,\tmetastatic\tcancer,\tor\talcoholic-related\tliver\tdiseases.\tCytokines\tand\tother | [
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medications,\tminerals,\tions,\tfatty\tacids,\tamino\tacids,\tand\tmetabolites.\tA\tmajor\trole\tof\talbumin\tis\tto\nmaintain\tcolloidal\tosmotic\tpressure,\tproviding\tapproximately\t80%\tof\tcolloidal\tosmotic\tpressure\n\tof\nthe\tplasma.\tWhen\tserum\talbumin\tlevels\tdecrease,\tthe\twater\tin\tthe\tplasma\tmoves\tinto\tthe\tinterstitial | [
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compartment\tand\tedema\tresults.\tThis\tloss\tof\tplasma\tfluid\tresults\tin\thypovolemia,\twhich\ttriggers\nrenal\tretention\tof\twater\tand\tsodium.\nAlbumin\thas\ta\thalf-life\tof\t18\tto\t21\tdays.\tLevels\tof\talbumin\tremain\tnearly\tnormal\tduring\nuncomplicated\tstarvation\tas\tredistribution\tfrom\tthe\tinterstitium\tto\tthe\n\tplasma\toccurs.\tLevels\tof | [
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plasma\toccurs.\tLevels\tof\nalbumin\tfall\tprecipitously\tin\tinflammatory\tstress\tand\toften\tdo\tnot\timprove\twith\taggressive\tnutrition\nsupport.\tSerum\tlevels\treflect\tthe\tseverity\tof\tillness\tbut\tdo\tnot\treflect\tcurrent\tprotein\tstatus\tor\tthe\neffects\tof\tnutrient-dense\tsupplemental\tnutrition.\tFor\tthese\treasons,\ta\twell-nourished\tbut\tstressed | [
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true\tcause\tof\tan\televated\tor\tdepressed\talbumin\tlevel.\nAlbumin\tis\tsynthesized\tin\tthe\tliver\tand\tis\ta\tmeasure\tof\tliver\tfunction.\tWhen\tdisease\taffects\tthe\nliver,\tthe\tsynthesis\tof\talbumin,\n\tby\tthe\thepatocytes,\tis\timpaired.\tBecause\tof\tthe\thalf-life\tof\talbumin,\nsignificant\tchanges\tin\tliver\tfunction\tare\tnot\timmediately\tapparent.\nPrealbumin\t(transthyretin) | [
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] |
Prealbumin\t(transthyretin)\nPrealbumin\t(PAB)\n,\tofficially\t\ntransthyretin\t(TTHY)\n,\tis\ta\thepatic\tprotein\ttransported\tin\tthe\tserum\nas\ta\tcomplex\tof\tretinol-binding\tprotein\tand\tvitamin\tA.\tIt\ttransports\tthe\tthyroid\thormones\ntriiodothyronine\tand\tthyroxine\t(T\n4\n),\talong\n\twith\tT\n4\n-binding\tglobulin.\tIt\thas\ta\tshort\thalf-life\t(t½\t=\t2 | [
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] |
levels\tstimulate\tPAB\tsynthesis\tand\tserum\tlevels\tmay\tincrease.\tIn\tnephrotic\tsyndrome,\tPAB\tlevels\nalso\tmay\tbe\tincreased.\tProteinuria\tand\thypoproteinemia\tare\tcommon\tin\tnephrotic\tsyndrome,\tand\nbecause\tPAB\tis\tsynthesized\trapidly,\ta\tdisproportionate\tpercentage\n\tof\tPAB\tcan\texist\tin\tthe\tblood,\nwhereas\tother\tproteins\ttake\tlonger\tto\tproduce\t( | [
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] |
whereas\tother\tproteins\ttake\tlonger\tto\tproduce\t(\nLitchford,\t2017\n).\nRetinol-binding\tprotein\nThe\thepatic\tprotein\twith\tthe\tshortest\thalf-life\t(t\t½\t=\t12\thr)\tis\t\nretinol-binding\tprotein\t(RBP)\n,\ta\nsmall\tplasma\tprotein\tthat\tdoes\tnot\tpass\tthrough\tthe\trenal\tglomerulus\tbecause\tit\tcirculates\tin\ta\ncomplex\twith\tPAB.\tAs\timplied\tby\tits\tname,\tRBP\tbinds\t\nretinol | [
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complex\twith\tPAB.\tAs\timplied\tby\tits\tname,\tRBP\tbinds\t\nretinol\n,\tand\ttransport\tof\n\tthis\tvitamin\tA\nmetabolite\tseems\tto\tbe\tits\texclusive\tfunction.\tRBP\tis\tsynthesized\tin\tthe\tliver\tand\treleased\twith\nretinol.\tAfter\tRBP\treleases\tretinol\tin\tperipheral\ttissue,\tits\taffinity\tfor\tPAB\tdecreases,\tleading\tto | [
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refeeding.\tRBP\tmay\tnot\treflect\tprotein\tstatus\tin\tacutely\tstressed\tpatients.\tIt\tmay\teven\tbe\televated\nwith\trenal\tfailure\tbecause\tthe\tRBP\tis\tnot\tbeing\tcatabolized\tby\tthe\trenal\ttubule.\nRBP4\tis\tan\tadipocyte-derived\tpeptide\tof\tRBP\tthat\tinfluences\tglucose\thomeostasis\tand\tlipoprotein\nmetabolism.\tHuman\tclinical | [
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metabolism.\tHuman\tclinical\n\ttrials\thave\tdemonstrated\tincreased\tRBP4\tlevels\tin\tobesity,\tinsulin\nresistance,\tgestational\tdiabetes,\tproliferative\tdiabetic\tretinopathy,\tand\tnondiabetic\tstage\t5\tchronic\nkidney\tdisease,\tischemic\tstroke,\tsuggesting\ta\tpossible\trelationship\tbetween\tthese\tconditions.\tLarger | [
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clinical\ttrials\tare\tneeded\tto\tdefine\tthis\trelationship\t(\nXun\tet\tal,\t2018\n;\t\nPerduca\tet\tal,\t2018\n;\t\nKlisić\tet\tal,\n2017\n;\t\nZhou\tet\tal,\t2017\n). | [
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Transferrin\nTransferrin\n\tis\ta\tglobulin\tprotein\tthat\ttransports\tiron\tto\tthe\tbone\tmarrow\tfor\tproduction\tof\nhemoglobin\t(Hgb)\n.\tThe\tplasma\ttransferrin\tlevel\tis\tcontrolled\tby\tthe\tsize\tof\tthe\tiron\tstorage\tpool.\nWhen\tiron\tstores\tare\tdepleted,\ttransferrin\tsynthesis\tincreases.\tIt\thas\ta\tshorter\thalf-life\t(t½\t=\t8\tdays) | [
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than\talbumin.\tLevels\tdiminish\twith\tacute\tinflammatory\treactions,\tmalignancies,\tcollagen\n\tvascular\ndiseases,\tand\tliver\tdiseases.\tTransferrin\tlevels\treflect\tinflammation\tand\tare\tnot\tuseful\tas\ta\tmeasure\nof\tprotein\tstatus.\nImmunocompetence\nInflammation-related\tmalnutrition\tis\tassociated\twith\timpaired\timmunocompetence,\tincluding | [
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] |
depressed\tcell-mediated\timmunity,\tphagocyte\tdysfunction,\tdecreased\tlevels\tof\tcomplement\ncomponents,\treduced\tmucosal\tsecretory\tantibody\tresponses,\tand\tlower\n\tantibody\taffinity.\tAssessing\nimmunocompetence\t(i.e.,\teosinophils)\tis\talso\tuseful\tin\tthe\tpatient\twho\tis\tbeing\ttreated\tfor\tallergies\n(see\t\nChapter\t25\n). | [
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] |
(see\t\nChapter\t25\n).\nThere\tis\tno\tsingle\tmarker\tfor\timmunocompetence\texcept\tfor\tthe\tclinical\toutcome\tof\tinfection\tor\nallergic\tresponse.\tLaboratory\tmarkers\twith\ta\thigh\tdegree\tof\tsensitivity\tinclude\tvaccine-specific\nserum\tantibody\tproduction,\tdelayed-type\thypersensitivity\n\tresponse,\tvaccine-specific\tor\ttotal | [
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convention,\tanemia\tis\tdefined\tas\tHgb\tconcentration\tbelow\tthe\t95th\tpercentile\tfor\thealthy\treference\npopulations\tof\tmen,\twomen,\tor\tage-grouped\tchildren.\tAnemia\tis\tnot\ta\tdisease\n\tbut\ta\tsymptom\tof\nvarious\tconditions,\tincluding\textensive\tblood\tloss,\texcessive\tblood\tcell\tdestruction,\tor\tdecreased | [
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blood\tcell\tformation.\tIt\tis\tobserved\tin\tmany\thospitalized\tpatients\tand\tis\toften\ta\tsymptom\tof\ta\tdisease\nprocess;\tits\tcause\tshould\tbe\tinvestigated.\tClinical\tnutritionists\tmust\tdistinguish\tbetween\tanemia\ncaused\tby\tnutritional\tinadequacies\tand\tthat\tcaused\tby\tother\tfactors\t(i.e.,\tdehydration\n\tmasking\nfalsely\tlow\tblood\tvalues).\tSee\t\nChapter\t31 | [
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] |
masking\nfalsely\tlow\tblood\tvalues).\tSee\t\nChapter\t31\n\tfor\tdiscussion\tof\tthe\tmanagement\tof\tanemias.\nClassification\tof\tanemia\nNutritional\tdeficits\tare\ta\tmajor\tcause\t\nof\tdecreased\tHgb\tand\terythrocyte\tproduction.\tThe\tinitial\ndescriptive\tclassification\tof\tanemia\tis\tderived\tfrom\tthe\t\nhematocrit\t(Hct)\n\tvalue\tor\tCBC\tas\texplained\nin\t\nTable\t5.2 | [
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] |
hematocrit\t(Hct)\n\tvalue\tor\tCBC\tas\texplained\nin\t\nTable\t5.2\n.\tAnemias\tassociated\twith\ta\tmean\tRBC\tvolume\tof\tless\tthan\t80\n\tfl\t(femtoliters)\tare\nmicrocytic;\tthose\twith\tvalues\tof\t80\tto\t99\tfl\tare\tnormocytic;\tthose\tassociated\twith\tvalues\tof\t100\tfl\tor\nmore\tare\tmacrocytic\t(see\t\nChapter\t32\n).\tData\tfrom\tthe\tCBC\tare\thelpful\tin\tidentifying\tnutritional | [
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] |
).\tData\tfrom\tthe\tCBC\tare\thelpful\tin\tidentifying\tnutritional\ncauses\tof\tanemia.\t\nMicrocytic\tanemia\n\tis\tassociated\tmost\toften\twith\tiron\tdeficiency,\twhereas\nmacrocytic\tanemia\n\tgenerally\tis\tcaused\tby\teither\tfolate-\tor\tvitamin\tB\n12\n–deficient\terythropoiesis. | [
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12\n–deficient\terythropoiesis.\nHowever,\tbecause\tof\tthe\tlow\tspecificity\tof\tthese\tindexes,\tadditional\tdata\tare\tneeded\tto\tdistinguish\nbetween\tthe\tvarious\tnutritional\tcauses\tand\tnonnutritional\tcauses,\tsuch\tas\tthalassemia\ttrait\tand\nchronic\trenal\tinsufficiency.\tNormocytic\tanemia\tis\tassociated\twith\tthe\t\nanemia\tof\tchronic\tand\ninflammatory\tdisease\t(ACD) | [
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platelet\tcounts.\tWhen\tlevel\tof\tleukocytes,\treticulocytes,\tand\nplatelet\tcounts\tare\tlow,\tthe\tpattern\tof\tresults\tsuggests\tmarrow\tfailure.\tElevated\tlevels\tof\tleukocytes,\nreticulocytes,\tand\tplatelet\tcounts\tare\tassociated\twith\tanemia\tand\tlikely\tcaused\tby\tleukemia\tor | [
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infection.\tESR\ttesting\tis\tordered\twhen\tsymptoms\tare\tnonspecific\tand\tif\tinflammatory\tautoimmune\ndiseases\tare\tsuspected.\tReticulocytes\tare\tlarge,\n\tnucleated,\timmature\tRBCs\tthat\tare\treleased\tin\nsmall\tnumbers\twith\tmature\tcells.\tWhen\tRBC\tproduction\trates\tincrease,\treticulocyte\tcounts\talso | [
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12\n\tdeficiency.\tThe\tpresence\tof\tmacrocytic\nRBCs\trequires\tevaluation\tof\tfolate\tand\tvitamin\tB\n12\n\tstatus.\tDNA\tsynthesis\tis\taffected\tnegatively\tby\ndeficiencies\tof\tfolic\tacid\tand\tvitamin\tB\n12,\n\tresulting\tin\timpaired\tRBC\tsynthesis\tand\tmaturation\tof\nRBCs.\tThese\tchanges\tcause\tlarge,\tnucleated\tcells\n\tto\tbe\treleased\tinto\tthe\tcirculation.\tAlthough\nvitamin\tB | [
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to\tbe\treleased\tinto\tthe\tcirculation.\tAlthough\nvitamin\tB\n12\n–related\tanemia\tis\tcategorized\tas\ta\tmacrocytic\tnormochromic\tanemia,\tapproximately\n40%\tof\tthe\tcases\tare\tnormocytic.\nMarkers\tof\tiron\tdeficiency\tanemias | [
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Hematocrit\tor\tpacked\tcell\tvolume\tand\themoglobin\nHct\tand\tHgb\tare\tpart\tof\ta\troutine\tCBC\tand\tare\tused\ttogether\tto\tevaluate\tiron\tstatus.\tHct\tis\tthe\nmeasure\tof\tthe\tpercentage\tof\tRBCs\tin\ttotal\n\tblood\tvolume.\tUsually\tthe\tHct\tpercentage\tis\tthree\ttimes\nthe\tHgb\tconcentration\tin\tgrams\tper\tdeciliter.\tThe\tHct\tvalue\tis\taffected\tby\tan\textremely\thigh\tWBC | [
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of\tHgb\tin\tthe\tperipheral\tblood.\tIt\tis\ta\nmore\tdirect\tmeasure\tof\tiron\tdeficiency\tthan\tHct\tbecause\tit\tquantifies\ttotal\tHgb\tin\tRBCs\trather\tthan\na\tpercentage\tof\ttotal\tblood\tvolume.\tHgb\tand\tHct\tare\tbelow\tnormal\tin\tthe\tfour\ttypes\tof\tnutritional\nanemias\tand\talways\tshould\tbe\tevaluated\tin\tlight\tof\tother\tlaboratory\tvalues\tand\trecent\tmedical\nhistory\t(see | [
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history\t(see\t\nChapter\t31\n).\nSerum\tferritin\nFerritin\tis\tthe\tstorage\n\tprotein\tthat\tsequesters\tthe\tiron\tnormally\tgathered\tin\tthe\tliver\n(reticuloendothelial\tsystem),\tspleen,\tand\tmarrow.\tAs\tthe\tiron\tsupply\tincreases,\tthe\tintracellular\tlevel\nof\tferritin\tincreases\tto\taccommodate\tiron\tstorage.\tA\tsmall\tamount\tof\tthis\tferritin\tleaks\tinto\tthe | [
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inadequate\tmobilization\tof\tiron\tfrom\tits\tstorage\tsites.\tIn\tthose\twith\tchronic\tinflammatory\tconditions\n(i.e.,\tarthritis)\tdepletion\tof\tstored\tiron\tdevelops\tpartly\tbecause\tof\treduced\tabsorption\tof\tiron\tfrom\nthe\tgut\tdue\tto\trelease\tof\thepcidin.\tAlso\tthe\tregular\tuse\tof\tnonsteroidal\tantiinflammatory\n\tdrugs\tcan | [
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dietary\tiron\tintake\tis\tlow,\tsaturation\tof\ttransferrin\tdecreases.\nThere\tare\texceptions\tto\tthe\tgeneral\trule\tthat\ttransferrin\n\tsaturation\tdecreases\tand\tTIBC\tincreases\nin\tpatients\twith\tiron\tdeficiency.\tFor\texample,\tTIBC\tincreases\tin\tthose\twith\thepatitis.\tIt\talso\tincreases | [
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in\tpeople\twith\thypoxia,\twomen\twho\tare\tpregnant,\tor\tthose\ttaking\toral\tcontraceptives\tor\treceiving\nestrogen\treplacement\ttherapy.\tOn\tthe\tother\thand,\tTIBC\tdecreases\tin\tthose\twith\tmalignant\tdisease,\nnephritis,\tand\themolytic\tanemias.\tFurthermore,\tthe\tplasma\tlevel\n\tof\ttransferrin\tmay\tbe\tdecreased\tin | [
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of\ttransferrin\tmay\tbe\tdecreased\tin\nthose\twith\tmalnutrition,\tfluid\toverload,\tand\tliver\tdisease.\tThus\talthough\tTIBC\tand\ttransferrin\nsaturation\tare\tmore\tspecific\tthan\tHct\tor\tHgb\tvalues,\tthey\tare\tnot\tperfect\tindicators\tof\tiron\tstatus.\nAn\tadditional\tconcern\tabout\tthe\tuse\tof\tserum\tiron,\tTIBC,\tand\ttransferrin\tsaturation\tvalues\tis\tthat | [
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thymidine\tmonophosphate.\tFolate\tand\tvitamin\tB\n12\n\tare\tused\tat\tdifferent\tsteps\tof\tthe\tsynthetic\npathway.\tImpaired\tRBC\tsynthesis\toccurs\tand\tlarge,\tnucleated\tRBCs\tthen\tare\treleased\tinto\tthe\ncirculation\t(see\t\nChapter\t31\n).\nAssessing\tfolate\tand\tvitamin\tB\n12\n\tstatus\nEvaluation\n\tfor\tmacrocytic\tanemia\tincludes\tstatic\tmeasurement\tof\tfolate\tand\tvitamin\tB\n12 | [
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are\trequired\tfor\tthe\tsynthesis\tof\tS-adenosylmethionine\t(SAM),\n\tthe\nbiochemical\tprecursor\tinvolved\tin\tthe\ttransfer\tof\tone-carbon\t(methyl)\tgroups\tduring\tmany\nbiochemical\tsyntheses.\tSAM\tis\tsynthesized\tfrom\tthe\tamino\tacid\tmethionine\tby\ta\treaction\tthat\nincludes\tthe\taddition\tof\ta\tmethyl\tgroup\tand\tthe\tpurine\tbase\tadenine\t(from\tadenosine\ttriphosphate, | [
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or\tATP).\tFor\texample,\twhen\tSAM\tdonates\ta\tmethyl\tgroup\tfor\tthe\tsynthesis\tof\tthymidine,\tcholine,\ncreatine,\tepinephrine,\n\tand\tprotein\tand\tDNA\tmethylation,\tit\tis\tconverted\tto\tS-adenosylhomocysteine.\nAfter\tlosing\tthe\tadenosyl\tgroup,\tthe\tremaining\t\nhomocysteine\n\tcan\tbe\tconverted\teither\tto\tcysteine\tby\nthe\tvitamin\tB\n6 | [
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12\n\tis\tlacking,\tthe\thomocysteine-to-methionine\treaction\n\tis\tblocked,\ncausing\thomocysteine\tto\tbuild\tup\tin\tthe\taffected\ttissue\tand\tspill\tinto\tthe\tcirculation.\tThe\tvitamin\tB\n6\n–\ndependent\ttranssulfuration\tpathway\tcan\tmetabolize\texcess\thomocysteine.\tHomocysteine\thas\tbeen\nshown\tto\tbe\tsensitive\tto\tfolate\tand\tvitamin\tB\n12\n\tdeficiency. | [
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] |
shown\tto\tbe\tsensitive\tto\tfolate\tand\tvitamin\tB\n12\n\tdeficiency.\nTherefore\tan\televated\thomocysteine\tlevel\tindicates\teither\tgenetic\tdefects\tinvolved\tin\tthe\tenzymes\nthat\tcatalyze\tthese\treactions,\n\tor\ta\tdeficiency\tin\tfolate,\tvitamin\tB\n12\n,\tor\tvitamin\tB\n6\n.\tResearch\tindicates | [
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12\n,\tor\tvitamin\tB\n6\n.\tResearch\tindicates\nthat\tseveral\tfolate\tgene\tpolymorphisms\taffecting\tthe\tmethylation\tof\tfolate\tand\tB\n12\n\tcontribute\trisk\tfor\nseveral\tchronic\tcardiovascular\tand\tneurologic\tdisorders\t(\nKagawa\tet\tal,\t2017\n;\tsee\t\nChapters\t6\n\tand\n42\n).\nFolate\tassessment.\nFolate\tmost\toften\tis\tmeasured | [
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and\n42\n).\nFolate\tassessment.\nFolate\tmost\toften\tis\tmeasured\t\nsimultaneously\tin\twhole\tblood\twith\tits\tcombined\tamount\tfrom\tplasma\nand\tblood\tcells,\tand\tin\tthe\tserum\talone.\tThe\tdifference\tbetween\t\nwhole-blood\tfolate\tand\tserum\tfolate\nlevels\tthen\tis\tused\tto\tcalculate\ttotal\tRBC\tfolate\tconcentration.\tRBC\tfolate\tconcentration\tis\ta\tbetter | [
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