diabetestalk.net

Pernicious Anemia And A1c

Anemia

Anemia

On this site Tests: Iron Tests, Serum Iron, Ferritin, TIBC, UIBC, and Transferrin, Complete Blood Count, Hemoglobin, Hematocrit, White Blood Cell Differential Count, Reticulocyte Count, Bone Marrow Aspiration and Biopsy, Blood Smear, Sickle Cell Tests, Vitamin B12 and Folate, G6PD, Direct Antiglobulin Test, Haptoglobin, Intrinsic Factor Antibody, Parietal Cell Antibody, Methylmalonic Acid, Erythropoietin, Fecal Occult Blood Test and Fecal Immunochemical Test, Hemoglobinopathy Evaluation, H. pylori, Soluble Transferrin Receptor Conditions: Sickle Cell Anemia, Thalassemia, Bone Marrow Disorders, Malnutrition, Vitamin B12 and Folate Deficiency, Hemoglobin Abnormalities Screening: Pregnancy - First Trimester: Hemoglobin; Infants: Iron deficiency anemia; Children: Iron deficiency anemia; Teens: Iron deficiency anemia Elsewhere on the Web Continue reading >>

Vitamin B12 Deficiency

Vitamin B12 Deficiency

Also known as Cobalamin Deficiency and Cyanocobalamin Deficiency Vitamin B12 deficiency or hypocobalaminemia is a low blood level of vitamin B12. It can cause permanent damage to nervous tissue if left untreated longer than 6 months. Vitamin B12 itself was discovered through investigation of pernicious anemia, which is an autoimmune disease that destroys parietal cells in the stomach that secrete intrinsic factor. Pernicious anemia, if left untreated, is usually fatal within three years. Once identified, however, the condition can be treated successfully and with relative ease, although it cannot be cured and ongoing treatment is required. Humans obtain almost all of their vitamin B12 from dietary means. Pernicious anemia is usually the result of insufficient secretion of intrinsic factor within the stomach. Other more subtle types of vitamin B12 deficiency have been elucidated, including the biochemical effects, over the course of time in significant numbers. Source: Wikipedia What are the symptoms? Within all the people who go to their doctor with vitamin b12 deficiency, 36% report having fatigue, 14% report having disturbance of memory, and 14% report having paresthesia. The symptoms that are highly suggestive of vitamin b12 deficiency are abnormal appearing tongue, although you may still have vitamin b12 deficiency without those symptoms. Continue reading >>

Anemia And Hemoglobin A1c Level: Is There A Case For Redefining Reference Ranges And Therapeutic Goals?

Anemia And Hemoglobin A1c Level: Is There A Case For Redefining Reference Ranges And Therapeutic Goals?

Segun Adeoye, Sherly Abraham, Irina Erlikh, Sylvester Sarfraz, Tomas Borda and Lap Yeung. Abstract Background: Hemoglobin A1c (HbA1c) has been adopted by physicians as a surrogate for monitoring glycemic control. There exists concern that other factors beyond serum glucose concentration may affect glycation rates and by extrapolation HbA1c levels. Study Objectives: The study attempts to discern clinical differences in HbA1c levels in patients with anaemia compared to patients without anemia, quantifying and showing the direction of such differences. Study Design: Using a convenient sampling method and a set of inclusion and exclusion criteria, it examined (retrospectively) patterns in [Hb] and HbA1c in non-diabetics with and without anemia. Results: The study observed a statistically significant 0.4units (8%) difference in the mean HbA1c in anaemia vs. non-anaemic populations. Reference ranges of HbA1c for non-anaemic population and anaemia subtypes was computed. Computed ranges for anaemia group and its subgroups were significantly wider compared to non-anaemia population. Modest but statistically significant correction of anaemia did not result in significant changes in HbA1c. Discussion: i. The linear relationship between [Hb] and HbA1c holds true for anaemic and non-anaemia populations. ii. Non-diabetic, anaemic have a significantly lower mean HbA1c (5.3% vs. 5.7%), but a similar upper limit of reference range due to a higher variance. iii. The variance and proposed reference ranges for anaemia group and its subtypes was greater than in non-anaemia group, perhaps due to homogenization of clinically heterogeneous entities. iv. Modest correction anaemia did not cause significant change in HbAIc, perhaps the increase in [Hb] was too modest or persistence of correction Continue reading >>

Diabetes And B12: What You Need To Know

Diabetes And B12: What You Need To Know

Vitamin B12 is necessary for a healthy nervous system and healthy blood cells. The best way to get vitamin B12 is through your diet. This important vitamin is found in meat, fish, poultry, and dairy products. If you don’t eat enough of these foods, it could leave you with a deficiency. Consuming enough vitamin B12 isn’t the only problem. Your body also needs to be able to absorb it efficiently. Some medications like Pepcid AC, Prevacid, Prilosec, and Zantac, as well as others used to treat acid reflux, peptic ulcer disease, and infection, may make it harder for your body to absorb B12. Another medication that may interfere with B12 absorption is metformin, a common type 2 diabetes treatment. Simply having diabetes may make you more prone to B12 deficiency. A 2009 study found that 22 percent of people with type 2 diabetes were low in B12. Read on to learn the symptoms of B12 deficiency, what it could mean for your overall health, and what you can do about it. Symptoms of vitamin B12 deficiency may be mild at first, and not always obvious. If you’re slightly low on B12, you may not have any symptoms at all. Some of the more common early symptoms are: tiredness weakness loss of appetite weight loss constipation It may be easy to dismiss these as minor complaints, but over time, insufficient B12 can lead to bigger problems. Very low levels of B12 can result in serious complications. One of these is called pernicious anemia. Anemia means you don’t have enough healthy red blood cells. This deprives your cells of much-needed oxygen. According to a study in the Journal of Oral Pathology Medicine, less than 20 percent of those with a B12 deficiency experience pernicious anemia. Symptoms of anemia include: fatigue pale skin chest pain dizziness headache You may even lose Continue reading >>

Reference Ranges For Hemoglobin A1c:

Reference Ranges For Hemoglobin A1c:

Laboratory reference range: 4.8–5.6% Functional reference range: 4.6–5.3% DESCRIPTION: Hemoglobin A1c is a subtype of hemoglobin that is non-enzymatically glycosylated by circulating glucose. The action of hemoglobin A1c is indistinguishable from other subtypes of hemoglobin; however, measuring levels of hemoglobin A1c in the blood is useful for estimating average levels of blood glucose over a three-month period. Therefore, hemoglobin A1c can be used to inform diabetes mellitus diagnosis and monitor the efficacy of exercise, dietary management, and treatment of diabetes.1 Hemoglobin in newly formed red blood cells contains negligible amounts of covalently bound glucose, yet glucose can freely permeate the cell membranes of red blood cells.1 Thus, glucose can freely interact with hemoglobin molecules within red blood cells. The N-terminus of the beta chain of hemoglobin non-covalently interacts with glucose, then proceeds through a Schiff base and Amadori rearrangement to form a covalent bond between glucose and hemoglobin.2 Over the following weeks, these Amadori rearrangement products transition to intermediate and advanced glycosylation endproducts.3,4 These reactions are irreversible and persist for the life of the red blood cell. This non-enzymatic covalent bonding of glucose and hemoglobin takes place in a dose-dependent fashion, such that greater amounts of circulating glucose correspond to higher levels of glycosylated hemoglobin, or hemoglobin A1c. The typical lifespan of a red blood cell is 120 days, with approximately 1 percent of the entire erythrocyte population degrading and replenishing itself daily.1,5 Taken together, this indicates that any spot assessment of hemoglobin A1c level in the blood provides an average circulating glucose level for the pre Continue reading >>

What Is A Complete Blood Count (cbc)?

What Is A Complete Blood Count (cbc)?

The CBC is used as a broad screening test to check for such disorders as anemia, infection, and many other diseases. It is actually a panel of tests that examines different parts of the blood and includes the following: • White blood cell (WBC) count is a count of the actual number of white blood cells per volume of blood. Both increases and decreases can be significant. • White blood cell differential looks at the types of white blood cells present. There are five different types of white blood cells, each with its own function in protecting us from infection. The differential classifies a person’s white blood cells into each type: neutrophils, lymphocytes, monocytes, eosinophils, and basophils. • Red blood cell (RBC) count is a count of the actual number of red blood cells per volume of blood. Both increases and decreases can point to abnormal conditions. • Hemoglobin measures the amount of oxygen-carrying protein in the blood. • Hematocrit measures the percentage of red blood cells in a given volume of whole blood. • The platelet count is the number of platelets in a given volume of blood. Both increases and decreases can point to abnormal conditions of excess bleeding or clotting. Mean platelet volume (MPV) is a machine-calculated measurement of the average size of your platelets. New platelets are larger, and an increased MPV occurs when increased numbers of platelets are being produced. MPV gives your doctor information about platelet production in your bone marrow. • Mean corpuscular volume (MCV) is a measurement of the average size of your RBCs. The MCV is elevated when your RBCs are larger than normal (macrocytic), for example in anemia caused by vitamin B-12 deficiency. When the MCV is decreased, your RBCs are smaller than normal (microcytic) a Continue reading >>

Effect Of Iron Deficiency Anemia On Hemoglobin A1c Levels

Effect Of Iron Deficiency Anemia On Hemoglobin A1c Levels

Go to: Abstract Background Iron deficiency anemia is the most common form of anemia in India. Hemoglobin A1c (HbA1c) is used in diabetic patients as an index of glycemic control reflecting glucose levels of the previous 3 months. Like blood sugar levels, HbA1c levels are also affected by the presence of variant hemoglobins, hemolytic anemias, nutritional anemias, uremia, pregnancy, and acute blood loss. However, reports on the effects of iron deficiency anemia on HbA1c levels are inconsistent. We conducted a study to analyze the effects of iron deficiency anemia on HbA1c levels and to assess whether treatment of iron deficiency anemia affects HbA1c levels. Fifty patients confirmed to have iron deficiency anemia were enrolled in this study. HbA1c and absolute HbA1c levels were measured both at baseline and at 2 months after treatment, and these values were compared with those in the control population. The mean baseline HbA1c level in anemic patients (4.6%) was significantly lower than that in the control group (5.5%, p<0.05). A significant increase was observed in the patients' absolute HbA1c levels at 2 months after treatment (0.29 g/dL vs. 0.73 g/dL, p<0.01). There was a significant difference between the baseline values of patients and controls (0.29 g/dL vs. 0.74 g/dL, p<0.01). Conclusions In contrast to the observations of previous studies, ours showed that HbA1c levels and absolute HbA1c levels increased with treatment of iron deficiency anemia. This could be attributable to nutritional deficiency and/or certain unknown variables. Further studies are warranted. Keywords: Iron deficiency anemia, Hemoglobin A1c, HbA1c, Glycated hemoglobin Go to: INTRODUCTION Hemoglobin A1c (HbA1c) is a glycated hemoglobin that can be used as an indicator of a patient's glycemic stat Continue reading >>

What Nutritional Supplements Help Raise Hemoglobin Levels?

What Nutritional Supplements Help Raise Hemoglobin Levels?

You can live days without water and weeks without food. Lack of oxygen, however, kills within minutes. Hemoglobin is the vital protein in your red blood cells that transports oxygen from your lungs to your tissues. A low hemoglobin level compromises oxygen delivery to your tissues. Many conditions and diseases can cause a low hemoglobin level, or anemia, including certain nutritional deficiencies. Supplements can help to raise a low hemoglobin level caused by a nutritional deficiency, but they will not correct anemia due to another underlying cause. Video of the Day Iron deficiency is the most common cause of anemia in the United States. You may develop an iron deficiency from inadequate nutritional intake, reduced intestinal absorption or blood loss. Microscopic examination of your blood and tests to measure your iron stores help your doctor determine whether you have a deficiency. Iron supplements and an iron-rich diet are standard treatments for mild to moderate iron-deficiency anemia. Your doctor may recommend a blood transfusion, iron shots or intravenous iron if you have a critically low hemoglobin level. Vitamin B-12 Your hemoglobin level and red blood cell count may drop to abnormally low levels with a vitamin B-12 deficiency. Vitamin B-12 deficiency anemia is also known as pernicious anemia and megaloblastic anemia. Your diet may not contain enough vitamin B-12, especially if you follow a strict vegan nutrition plan. Poor absorption of vitamin B-12 can also cause megaloblastic anemia. Your doctor will request blood tests to determine if a B-12 deficiency is responsible for your anemia. Other tests may also be needed. Your doctor may prescribe vitamin B-12 shots, oral supplements, or both, to treat your condition and raise your hemoglobin to a normal level. Fola Continue reading >>

Effect Of Iron Deficiency Anemia On The Levels Of Hemoglobin A1c In Nondiabetic Patients.

Effect Of Iron Deficiency Anemia On The Levels Of Hemoglobin A1c In Nondiabetic Patients.

Abstract The major form of glycohemoglobin is hemoglobin A1c (HbA1c). The HbA1c fraction is abnormally elevated in chronic hyperglycemic diabetic patients and correlates positively with glycemic control. Previous studies suggest that iron deficiency anemia (IDA) affects the levels of HbA1c. The aim of this study was to determine the effect of IDA on HbA1c levels in nondiabetic patients. The population studied consisted of 50 patients (30 women, 20 men, mean age 35.7 +/- 11.9 years) with IDA and 50 healthy subjects that were matched for age and sex. Patients who had glucose tolerance abnormalities (impaired glucose tolerance or diabetes mellitus), hemoglobinopathies, hemolytic anemia, chronic alcohol ingestion and chronic renal failure were excluded from the study. Hematologic investigations, fasting and postprandial glucose and HbA1c levels were measured in all subjects before iron therapy. All patients with IDA were treated with iron 100 mg/day for 3 months. We repeated the laboratory investigation after iron therapy. Before iron treatment, the mean HbA1c (7.4 +/- 0.8%) level in patients with IDA was higher than in a healthy group (5.9% +/- 0.5) (p < 0.001). In patients with IDA, HbA1c decreased significantly after iron treatment from a mean of 7.4% +/- 0.8 to 6.2% +/- 0.6 (p < 0.001). Iron deficiency must be corrected before any diagnostic or therapeutic decision is made based on HbA1c. Continue reading >>

High A1c In Some Subjects May Not Indicate Prediabetes

High A1c In Some Subjects May Not Indicate Prediabetes

A new study has shown that for people with iron-deficiency anemia, elevated A1c’s may not reflect glycemic parameter.… "The use of HbA1c to diagnose prediabetes and diabetes in iron-deficient populations may lead to a spuriously exaggerated prevalence," the researchers cautioned in their published report. Dr. Chittaranjan S. Yajnik of King Edward Memorial Hospital Research Center in Pune, India, wrote that, "A1c concentration depends not only on prevailing glycemia but also the life span of erythrocytes." "Iron deficiency increases erythrocyte survival and therefore disproportionately elevates HbA1c concentrations at a given glycemic level," they note. It the current study, the team studied 116 young adults enrolled in a longitudinal cohort study. Among this group, 34% were anemic, 37% were iron deficient, 40% were vitamin B12 deficient, and 22% were folate deficient, the authors note. Prediabetes was prevalent in 7.8% and diabetes in 2.6%, based on a standard oral glucose tolerance test (OGTT), while corresponding rates based on American Diabetes Association HbA1c criteria were 23.3% for prediabetes and 2.6% for diabetes, the researchers found. "A total of 24 participants who were normoglycemic by OGTT criteria were misclassified as having prediabetes or diabetes by HbA1c criteria, and six prediabetic or diabetic participants were misclassified as normal by HbA1c criteria," they report. On further analysis, HbA1c was predicted not only by higher glycemia but also by lower ferritin, the report indicates. "Our results support a substantial nonglycemic nutritional influence on HbA1c concentrations in young nondiabetic Indians," Dr. Yajnik and colleagues conclude. "This complicates the use of HbA1c in the diagnosis of prediabetes in nutritionally compromised population Continue reading >>

Anemia

Anemia

Anemia is a sign of an underlying issue with red blood cells (RBCs) and their ability to carry oxygen to tissues, resulting in hypoxia. It occurs when the total number of red cells is low or the amount of hemoglobin is low. Hemoglobin is the protein that carries oxygen on RBCs. Looking for the root cause of anemia is essential to determine the appropriate treatment. [1] Naturopathic Assessment In order to stimulate the innate ability of the body to heal the causes of disease must be identified and addressed. With anemia, the causes are variable. A detailed assessment is required to determine which factors are contributing. Generally there are three main causes of anemia: excessive blood loss (heavy menses, hemorrhage or chronic low-volume loss), easy destruction of red blood cells (hemolysis) or deficient production of red blood cells (ineffective hematopoiesis). Inadequate nutritional intake of iron, Vitamin B12 or folate; especially in developing countries or malnutrition in general can cause an inadequate production of red blood cells.[2] Skipping lunch and diets with low amounts of poultry and fish have been associated with increased risk of anemia. [2] Economic Status Low socioeconomic status is commonly associated with nutritional deficiency which causes 50% of all anemia especially in school aged children leading to chronic anemia.[2] Altitudes Medical Procedures Prescription Medications Salicylates such as aspirin or willow bark can lead to iron deficiency and anemia due to blood loss from hemorrhage.[3] Thalassemias are inherited disorders involving the four chains of protein that make up hemoglobin. There are two alpha chains and two beta chains therefore four possible subsets of Thalassemia depending on the degree of inheritance of affected genes. Thalassemia Continue reading >>

Metformin And Risk For Vitamin B12 Deficiency

Metformin And Risk For Vitamin B12 Deficiency

Metformin (brand names Glucophage, Glucophage XR, Fortamet, Riomet, Glumetza, and others) is a popular and highly effective oral diabetes drug used to help manage Type 2 diabetes. This drug works by lowering the amount of glucose made by the liver and by making the body’s cells more sensitive to insulin. Metformin also has some other beneficial effects in that it may help lower blood lipid, or fat, levels (cholesterol and triglycerides) and can, in some people, promote a small amount of weight loss. Metformin can be used with other diabetes pills and with insulin. Side effects of taking metformin are relatively rare, the most common being bloating, nausea, and diarrhea, all of which are temporary. Some people shouldn’t take metformin, including people with kidney disease, liver disease, or congestive heart failure, for example, because of an increased risk of a potentially fatal condition called lactic acidosis. In recent years, there’s been some concern over the risk of vitamin B12 deficiency in people who take metformin. Vitamin B12 (also known as cyanocobalamin or cobalamin) plays many important roles in the body, such as keeping your blood cells and nervous system in tip top shape. There’s also some evidence that vitamin B12 may help prevent heart disease and possibly even Alzheimer disease (the jury is still out on this one). This vitamin is found primarily in animal foods, such as beef, seafood, eggs, and dairy products, which is why some vegetarians are at risk for a B12 deficiency. Elderly people are often at risk for deficiency as well, due to problems with absorption from the gastrointestinal tract. Symptoms of B12 deficiency include certain types of anemia, neuropathy, memory loss, confusion, and even dementia. So, why would taking metformin possibly Continue reading >>

When Is Hemoglobin A1c Inaccurate In Assessing Glycemic Control?

When Is Hemoglobin A1c Inaccurate In Assessing Glycemic Control?

Faculty Peer Reviewed Hemoglobin A1C (HbA1c) is an invaluable tool for monitoring long-term glycemic control in diabetic patients. However, many clinicians managing diabetics have encountered the problem of HbA1c values that do not agree with fingerstick glucose logs. Before suspecting an improperly calibrated glucometer or poor patient record keeping, it is useful to consider the situations in which HbA1c may be spuriously elevated or depressed. These issues are best understood after reviewing how HbA1c is defined and measured–topics fraught with considerable confusion. Glycosylation is a non-enzymatic, time-dependent chemical reaction in which glucose binds to the amino groups of proteins.[1] Historically, and long before its precise chemistry was discovered, glycosylated Hb was defined as an area of an elution chromatogram containing hemoglobin glycosylation products. This elution peak was labeled as HbA1, in keeping with the existing nomenclature (HbA, HbA2, HbF, etc. had been identified previously). Later it was recognized that the chromatographic HbA1 region is not homogeneous and consists of several component peaks, designated A1a, A1b and A1c, with HbA1c being the dominant one.[1] The HbA1c fraction also turned out to correlate best with mean serum glucose concentrations, ie, to be a better index of long-term glycemia. Relatively recently HbA1c was redefined chemically: now glycohemoglobin refers to hemoglobin glycosylated at any of its amino groups, while HbA1c is defined as glycohemoglobin with glucose bound specifically to the terminal valine of the beta-globin chain. Consequently, the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) has developed a standard reference method for HbA1c in which hemoglobin is cleaved with a specif Continue reading >>

Macrocytic Anemia Is A Sign That Something Is Wrong!

Macrocytic Anemia Is A Sign That Something Is Wrong!

Macrocytic Anemia, also called Macrocytosis, is a condition of larger, oddly shaped and fewer red blood cells that occurs for a variety of reasons. Primarily this shows up on a blood test by a high number on the MCV Blood Test that is a portion of the Complete Blood Count- or CBC test- which is part of most routine blood tests. The condition gets its name from how it appears on the blood test. The word 'Macro' means large, as in a 'macro' lens on a camera. The prefix 'cy' or 'cyto' means cell and the word 'anemia' refers to any condition of fewer red blood cells or hemoglobin. Hence the word Macrocytic Anemia or macrocytosis. Macrocytic anemia is most often caused by an individual problem or a combination of problems such as: Alcoholism Folic Acid Deficiency Vitamin B6 Deficiency Malabsorption Problems such as Gluten Sensitivity or drug side effects such as: But regardless, a high MCV should prompt further investigation by your doctor into WHY you have this problem. However, it's VERY often the case that a high MCV blood test gets overlooked as not being significant- when it can be EXTREMELY significant to your health. In fact, when you begin Understanding Blood Test Results, you'll see that the finding of Macrocytosis can indicate serious conditions that have been causing your health problems for YEARS and are only now showing up on your blood test! If you have had chronic health conditions, macrocytic anemia could finally show what your problem has been all of this time. But ONLY if your doctor is vigilant about looking into the causes of macrocytic anemia and seeing it as the problem of serious nutritional deficiencies that it is- unfortunately, most doctors DON'T see it this way and don't understand about the serious health implications of the underlying causes of t Continue reading >>

Dr. Roach: Though Rare, Medication Can Be Cause Of Ed

Dr. Roach: Though Rare, Medication Can Be Cause Of Ed

Dear Dr. Roach: I am a 77-year-old man who has had erectile dysfunction for eight years. I have been on the following medications for over 12 years: atenolol, lisinopril and amlodipine for high blood pressure; metformin and glipizide for Type 2 diabetes. Recent lab results have shown normal testosterone level, A1C reading of 6 and BP of 128/78. Could there be a relationship between my medications and my ED? — R.F. Answer: Erectile dysfunction is a common problem in men, and is increasingly prevalent as men get older. Sometimes a cause is found, but often there isn’t. When there is a cause that’s found, it sometimes is due to medicine, but also can be traced to poor blood flow, damage to nerves, abnormal hormone levels or psychological factors. Poor blood flow in large blood vessels can cause ED. This means treatment is important, because men with blockages in the blood supply to the penis also may have blockages in the blood supply to the heart or brain, so it’s worth considering. Men with high blood pressure and diabetes are at higher risk for arterial blockages. Nerve damage can be due to trauma or nerve diseases. Diabetes increases the risk of all kinds of nerve diseases, but your A1C level indicates that you have good control of your diabetes, which makes this unlikely. A careful physical exam can answer this question. Testosterone levels frequently are abnormal in older men, but one other hormone I recommend checking in men with ED is prolactin: It can be a cause of ED, although rare. It can be produced by brain tumors. Psychological factors are the hardest to diagnose, but many of us physicians forget to even ask. If there are no clear reasons for ED, then I certainly would evaluate the medicines you are taking. Of your medications, atenolol is the most of Continue reading >>

More in diabetes