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 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 years20.1%39.0% Children years 5.9%48.1% Pregnant women 22.7%52.0% Women years 10.3%42.3% Men years04.3%30.0% Elderly > 60 years12.0%45.2% Anemia Prevalence (WHO) © WORLD HEALTH ORGANIZATION, 2001

Me and Rolls-Royce are same, We both need FUEL to move.

FormsStorage iron (Ferritin) Functioning iron Heme iron (Hemoglobin) Occurrence iron storage other tissueshemoglobin 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 2009 The 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 stage Iron deficiency syndrome IDS Fatigue Difficulty concentration Depressed mood Sleeping disturbance Neck tensions Headache Dizziness Loss of hair Early stage Iron deficiency syndrome IDS Fatigue Difficulty concentration Depressed mood Sleeping disturbance Neck tensions Headache Dizziness Loss of hair Late stage Iron deficiency anemia IDA Pallor (pale skin) General malaise Muscular weakness Dyspnea Palpitation Tachycardia Low blood pressure Iron deficiency stages The Underestimated Element 2009 The Rediscovery of the Iron Deficiency Syndrome

No

Neck tensions Depressed mood Sever Headache Migrane Loss of hair Sleeping 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 regulation breathing intestinal 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 Menopause 5-7 years of continuous bleeding General facts

Menstrual blood loss Ranging from ml mg of iron per period A women loses about 500 mg Of iron with each pregnancy General facts US Pharmacist 2007 M.Saljoughian,PharmD,PhD Alta 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 Manufacture No Metabolism Recycling

Papayannopoulou T, et al. In: Hoffman R, et al., ed. Hematology: Basic Principles and Practice. 4 th ed. 2005; SCF, GM-CSF, IL-3 SCF, IL-1, IL-3, IL-6, IL-11 Pluripotent Stem Cell Burst-Forming Unit-Erythroid Cells (BFU-E) Colony-Forming Unit-Erythroid Cells (CFU-E) ReticulocytesRBCsErythro- blasts Proerythro- blasts About 8 Days Iron Erythropoietin Erythropoiesis in CKD Erythropoiesis

E valuate other causes of anemia (bleeding) O btain CBC Hgb - RBCs count - MCV- MCH A ssess for adequate iron stores Ferritin 50 ng/ml or more TS 20% or more

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 Hb g/dL Risk 100% 50%

Efficient Absorption 23 times greater than iron salts Absorption is through the heme receptors Aong the GIT Compliant Taken with meals Taken with tea &coffee Not affected by Gastric acidity as it Does not need to change to Ferrous-Ferric- Ferrous Quality Made in Sweden

Constipation Cramping Heartburn Nausea

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 =