ArticleLiterature Review

The diagnosis and treatment of iron deficiency and its potential relationship to hair loss

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Iron deficiency is the world's most common nutritional deficiency and is associated with developmental delay, impaired behavior, diminished intellectual performance, and decreased resistance to infection. In premenopausal women, the most common causes of iron deficiency anemia are menstrual blood loss and pregnancy. In men and postmenopausal women, the most common causes of iron deficiency anemia are gastrointestinal blood loss and malabsorption. Hemoglobin concentration can be used to screen for iron deficiency, whereas serum ferritin concentration can be used to confirm iron deficiency. However, the serum ferritin concentration may be elevated in patients with infectious, inflammatory, and neoplastic conditions. Other tests may be needed, such as erythrocyte zinc protoporphyrin concentration, transferrin concentration, serum iron concentration, and transferrin saturation. The cause of iron deficiency must be identified. If the patient is male, postmenopausal female, or has risk factors for blood loss, then the patient should be evaluated for sources of blood loss, especially gastrointestinal (eg, colon cancer). Several studies have examined the relationship between iron deficiency and hair loss. Almost all have addressed women exclusively and have focused on noncicatricial hair loss. Some suggest that iron deficiency may be related to alopecia areata, androgenetic alopecia, telogen effluvium, and diffuse hair loss, while others do not. Currently, there is insufficient evidence to recommend universal screening for iron deficiency in patients with hair loss. In addition, there is insufficient evidence to recommend giving iron supplementation therapy to patients with hair loss and iron deficiency in the absence of iron deficiency anemia. The decision to do either should be based on clinical judgment. It is our practice at the Cleveland Clinic Foundation to screen male and female patients with both cicatricial and noncicatricial hair loss for iron deficiency. Although this practice is not evidence based per se, we believe that treatment for hair loss is enhanced when iron deficiency, with or without anemia, is treated. Iron deficiency anemia should be treated. Treating iron deficiency without anemia is controversial. Treatment of nutritional iron deficiency anemia includes adequate dietary intake and oral iron supplementation. Excessive iron supplementation can cause iron overload and should be avoided, especially in high-risk patients such as those with hereditary hemochromatosis. Patients who do not respond to iron replacement therapy should undergo additional testing to identify other underlying causes of iron deficiency anemia.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... 5 While one group has reported that supplementation with iron and L-lysine may reduce hair shedding or telogen hairs, there is no controlled study demonstrating that iron supplementation leads to hair regrowth in TE, with or without iron deficiency anemia. 2 Although controversial, iron supplementation in the absence of anemia is not recommended by some hematologic experts. 2 ...
... Iron deficiency anemia (IDA) is a downstream effect of long term iron deficiency. 2 Several uncontrolled studies with small test populations have demonstrated high rates of anemia amongst TE patients, 6 however a major controlled study found no difference in hemoglobin levels in patients with chronic TE and the control populations. 5 It is unclear whether population prevalence estimates of IDA are any different from controlled studies of subjects with TE. 2 While no studies have demonstrated that iron supplementation promotes hair regrowth in the setting of TE, when identified, IDA should be treated as the causes may range from heavy menstrual bleeding to malignant intestinal bleeding. ...
... Iron deficiency anemia (IDA) is a downstream effect of long term iron deficiency. 2 Several uncontrolled studies with small test populations have demonstrated high rates of anemia amongst TE patients, 6 however a major controlled study found no difference in hemoglobin levels in patients with chronic TE and the control populations. 5 It is unclear whether population prevalence estimates of IDA are any different from controlled studies of subjects with TE. 2 While no studies have demonstrated that iron supplementation promotes hair regrowth in the setting of TE, when identified, IDA should be treated as the causes may range from heavy menstrual bleeding to malignant intestinal bleeding. ...
... While some studies have demonstrated lower levels than controls, others have shown either no correlation or even the opposite result. [19][20][21][22][23] The most common nutritional deficiency in the world is iron deficiency, which contributes to TE. 24,25 The serum ferritin (iron-binding protein) level is considered to be a good indicator of total body iron stores and is relied upon as an indicator in hair loss studies. 26 However, serum ferritin levels may be raised in patients with inflammatory, infectious, and neoplastic conditions, and in those with liver disorders. ...
... In order to reverse severe hair loss due to TE, some authors recommend maintaining serum ferritin at levels of >40 ng/dL 36 or 70 ng/dL. 24 We found mean serum ferritin level to be 31.17 ng/dL which is within normal limits (5.12 -95.4 ng/ml). ...
Article
Full-text available
p class="abstract"> Background: Diffuse hair loss is a common complaint encountered by dermatologists in clinical practice and can be alarming to the patients. Chronic telogen effluvium (CTE) is characterized by an abrupt onset of diffuse loss of scalp hair persisting for more than six months, predominantly affecting healthy women in their fourth to fifth decade of life. Although CTE is considered to be associated with various nutritional deficiencies, currently the evidence to substantiate this assertion is conflicting. Methods: A cross-sectional study was conducted on 100 adult non-pregnant women with CTE to document serum ferritin, B12 and vitamin D levels in an attempt to validate their role as biochemical markers using Statistical package for social sciences (SPSS) version 25:0 and Fisher’s exact test. Results: Mean ferritin level was 31.17 ng/dL. 23% patients had serum ferritin levels lower than the normal range (13-150 ng/dL). Vitamin D levels (normal range 5.2-60.4 ng/ml, mean 21.41 ng/ml) were low (deficiency range) in 2%. Vitamin B12 levels (normal range 191-663 pg/ml, mean 239.79) were low in 35.7% patients. Other parameters like duration, family history, past history of treatment did not demonstrate any statistically significant correlation. Conclusions: Our study detected low levels of serum ferritin and vitamin B12 in approximately one-fourth and a third of females with chronic telogen effluvium respectively with vitamin D deficiency found in only a small proportion. Although a statistically significant correlation could not be established between these nutrients and participant age or other parameters; we concur with most authors who recommend that all females with diffuse hair loss deserve a thorough screening for nutritional deficiencies to facilitate prompt recognition and timely supplementation.</p
... In this review, serum ferritin levels were significantly associated with hair loss following MBS, but serum iron levels were not. Serum ferritin levels reflect a patient's total iron storage [42]. However, studies have shown that serum ferritin levels may be altered with infectious, inflammatory, and neoplastic conditions [42]. ...
... Serum ferritin levels reflect a patient's total iron storage [42]. However, studies have shown that serum ferritin levels may be altered with infectious, inflammatory, and neoplastic conditions [42]. That is why we have concluded that there is currently insufficient evidence to claim a role for iron deficiency as a causative factor for hair loss after MBS. ...
Article
Full-text available
Background Hair loss is a common complication after metabolic and bariatric surgery (MBS). There is a lack of published systematic review in the scientific literature on this topic. The aim of this study was to perform a systematic review and meta-analysis on hair loss after MBS in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Methods PubMed, CINAHL, EMBASE, Web of Science, SCOPUS, and four Chinese databases were searched. Data were pooled using Review Manager 5.3 and Stata 12.0, and subgroups were performed if necessary and feasible. Results A total of 18 studies (n = 2538) were included. The pooled results showed that the incidence of hair loss after MBS was 57% (95% CI 42–71%). It decreased with longer follow-up times. Hair loss was significantly more common in younger (mean difference (MD), − 2.45; 95% CI, − 4.26 to − 0.64; p = 0.008) women (OR, 3.87; 95% CI, 0.59 to 17.59; p = 0.08). Serum zinc (standardized mean difference (SMD), − 1.13; 95% CI, − 2.27 to 0.01, p = 0.05), folic acid (SMD = − 0.88, 95% CI − 1.29 to − 0.46, p < 0.0001), and ferritin levels (SMD, − 0.22; 95% CI, − 0.38 to − 0.05; p = 0.01), but not serum iron and vitamin B12, were associated with hair loss following MBS. Conclusions Hair loss is common after MBS especially in younger women, and those with low serum levels of zinc, folic acid, and ferritin. Prospective studies on larger cohorts are needed.
... [3,4] Comorbid diseases are common in FPHL. [5,6] Some of these comorbid conditions, including iron depletion, zinc deficiency, thyroid diseases, and autoimmune diseases, also contribute to hair loss, but the diagnosis is often masked by FPHL due to the overlapping features of clinical presentation. Therefore, laboratory tests are essential when evaluating patients with FPHL to identify the comorbid diseases accurately. ...
... Iron is a rate-limiting cofactor for ribonucleotide reductase, and iron deficiency may affect fast-proliferating hair follicle matrix cells significantly, even at a minor scale. [5] Gropper et al. first reported hair growth after iron supplementation in a group of nonanemic iron-deficient female patients with hair loss. [12] Hair loss may be initiated or exacerbated when the ferritin levels are <40 ng/mL (iron depletion). ...
Article
Background: Female pattern hair loss (FPHL) is the main cause of alopecia in women and has a debilitating impact on the quality of life. However, certain comorbid conditions causing hair loss are often masked by FPHL and may remain undetected. Hence, it is imperative to identify them to administer appropriate treatment. The necessity of laboratory tests to evaluate these comorbidities in patients with FPHL has not been established. Objectives: This study aimed to identify the frequency of comorbid abnormalities detected by laboratory tests in patients with FPHL. Methods: Routine laboratory test results of patients with FPHL, who visit our hair clinic for the first time, were retrospectively collected and analyzed. These tests assessed the serum testosterone, thyroid-stimulating hormone, free thyroxin, zinc and ferritin levels, hemoglobin, as well as antinuclear antibody (ANA), and rapid plasma reagin test results. The correlation between age and hair loss severity and the frequency of comorbidities was evaluated using subgroup analysis. Results: Among the 356 patients with FPHL, coexisting zinc deficiency, iron depletion, and thyroid abnormalities were common and present in 41.7%, 39.7%, and 11.3% of them, respectively. The rate of concomitantly increased ANA titers was relatively low (4.4%), while that of syphilis and high serum testosterone levels was extremely low (0.3% and 0%, respectively). Younger patients (
... Demir eksikliğinin vücutta meydana getirdiği birçok problemden bir tanesi de saç dökülmesidir (3). Hatta bu hastalığın etiyolojisinde en çok suçlanan faktörlerden biri olarak değerlendirilebilir (6,7). Hipertiroidide %55'lere, hipotiroidide ise %33'lere varan oranlarda saç dökülmesi şikâyeti görülebilmektedir (8)(9)(10). ...
... Yine çalışmamızda %1 hastada T4 düşüklüğü, %1 hastada T4 yüksekliği saptanmıştır. Yaygın saç kaybı ile gelen hastalarda istenecek tetkikler açısından ortak bir görüşe varılamamış olmakla birlikte demir eksikliği anemisinin araştırılması, ferritin, tiroid fonksiyon testleri, vitamin değerlerinin kontrolü önemli kabul edilmiştir(6). Demir eksikliği mevcut olan hastalara destek tedavi verilmesinin saç dökülmesini durdurduğu yönündeki veriler yetersiz olmakla birlikte tedavi hastanın kliniğine göre hekimin vereceği karar doğrultusunda olmalıdır (23). ...
... While Zinc levels (μg/dL) shows significant differences between all mentioned groups, among all the studied groups; between Control group and Hair Losing (pregnant) group; between Control group and Hair Losing (non-pregnant) group; and finally between Hair Losing (non-pregnant) group and Hair Losing (pregnant) group. Table (2) shows no significant differences among the studied groups according to the 3 age groups (≤18, [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] 4) . ...
... Iron deficiency is diagnosed by a drop in serum ferritin levels, which is a very specific observation. The most important lab test for iron insufficiency is serum ferritin (20). The average serum ferritin level in patients has been considerably lower compared to it in the healthy people in this investigation. ...
Article
Full-text available
Zinc and iron, for example, are crucial trace elements for pregnant women's health. This study has been conducted for the evaluation of zinc and ferritin status of pregnant women since these elements have significant effects on health of the pregnant women as well as the growing embryo in Al Muthanna Province/ Iraq. Seventy five samples of this study were gathered from the three studied groups (Control, pregnant women with Hair Losing and non-pregnant women with Hair Losing) in the Central Health Laboratory of Al Muthanna Province through the period from November 2020 to May 2021, blood samples were collected for further analysis Conclusions : According to the findings of this study, serum zinc and ferritin levels are frequently low in pregnant women who complain of hair loss. Overall, zinc and ferritin insufficiency in Iraq is a major public health concern. Improving nutritional diversity aids in solving the risk among the study participants.
... Ferritin is structurally a highly complex protein and the main iron storage site in non-erythroid cells. 7 Within the cell, smooth endoplasmic reticulum is responsible for the synthesis of ferritin. Usually, level of ferritin in serum is linked to intracellular level of ferritin, so reflects entire body ironstores. ...
... Usually, level of ferritin in serum is linked to intracellular level of ferritin, so reflects entire body ironstores. 7 Among nutritional deficiency disorder, iron insufficiency is the most frequently seen, which is reflected in blood complete picture and ferritin levels directly linked with sum of body iron stock. One of the study done in 1963 by Hard, measured serum iron level to document the link between iron deficit as a consequence of which patient experience hair loss. ...
Article
Full-text available
Background: Serum ferritin is a good indicator of quantifying the risk of hair loss among women. Iron lead to low serum ferritin level; therefore, a low serum ferritin level can precisely point toward iron deficiency. Objectives: To determine the mean serum ferritin levels in female patients with androgenetic alopecia. Study Design: Descriptive cross-sectional study Place and Duration of Study: Department of Dermatology, Fauji Foundation Hospital, Rawalpindi from 2nd October 2018 to 1st April 2019. Methodology: One hundred female patients with androgenic alopecia of all ages after puberty were included. Patients with scarring and other non-scarring alopecia, who had taken iron, vitamin B12, folic acid or multivitamin supplements, anticoagulants, anti-thyroid drugs, antimitotic drugs and oral contraceptives were excluded. After aseptic measures,5 ml of venous blood was drawn, into sterile and disposable plastic syringes. Serum ferritin was measured by enzyme immunoassay (EIA) test, based on sandwich ELISA. Results: Mean age was 33.94±6.29 years and 65 (65.0%) of patients ranged from 36 to 50 years. Average duration of disease was 6.25±2.43 months. Mean weight was 58.77±9.17 kg. Mean serum ferritin levels in female patients with androgenetic alopecia was 33.10±42.99ng/ml. Conclusion: Serum ferritin levels in female patients with androgenetic alopecia are low. Keywords: Androgenic alopecia, Serum ferritin levels
... 34,35 It is well known that iron deficiency anaemia is linked to hair loss, and the affected patients can benefit from oral iron supplementation. [36][37][38] Whether iron supplementation is also beneficial for patients with TE in the absence of iron deficiency anaemia is debatable, but data suggest benefit. 38 In patients with post-COVID-19 hair loss, serum ferritin levels should be evaluated to assessed iron storage and oral iron supplementation could enhance hair re-growth whenever serum levels of ferritin are beneath the reference threshold. ...
... [36][37][38] Whether iron supplementation is also beneficial for patients with TE in the absence of iron deficiency anaemia is debatable, but data suggest benefit. 38 In patients with post-COVID-19 hair loss, serum ferritin levels should be evaluated to assessed iron storage and oral iron supplementation could enhance hair re-growth whenever serum levels of ferritin are beneath the reference threshold. 39 The reference intervals for serum ferritin may vary across laboratories, but generally, the normal ranges are between 30 to 200 ng/mL for women and 30 to 300 ng/mL for men. ...
Article
Full-text available
Post-COVID-19 telogen effluvium has been largely reported as a sequela in the post-acute phase of COVID-19, causing major emotional distress among the affected patients. The affected individuals are further exposed to a vast amount of misinformation from the internet and social media and it is important for physicians to be familiar with the phenomenon and provide appropriate counselling to their patients regarding this condition. This article aims to review the evidence-based complementary strategies that can help enhance hair regrowth after post-COVID-19 hair loss, from psychological support and patient education to the importance of optimal nutrition and potential indications and benefits of oral nutritional supplementation, as well as the role of both topical and injectable hair growth stimulators.
... In studies on iron de ciency and alopecia, serum ferritin was used to de ne the cut-off value of iron de ciency ranging from 10 to 70 ug/L [1,20,21]. Studies evaluating the association between iron de ciency and telogen e uvium have yielded con icting results, and the value of iron supplementation in patients remains unclear [22][23][24]. Currently, there is no published evidence-based medical evidence on the association between iron de ciency and telogen e uvium and accepted serum ferritin level for de ning iron de ciency. ...
... Several studies have been published using different interventions, including iron with L-lysine [24,58], iron alone [59], and iron with spironolactone [60]. Two studies targeted interventions with ferritin levels > 50 µg/L[61] or 70 µg/L [23]. These studies were limited by small sample sizes and differences in ferritin levels. ...
Preprint
Full-text available
Iron deficiency has been associated with telogen effluvium, but currently, the data regarding their association are conflicting. To derive a more precise estimation of this association, we performed a systematic review and meta-analysis to investigate serum ferritin level, serum iron level, and prevalence of ferritin deficiency in all published studies. Databases including PubMed, Google Scholar, Offshore Vessel Inspection Database, and Cochrane Library, were systematically searched. The association was assessed using standardized mean differences, odds ratios, and 95% confidence intervals. Statistical analysis was performed using Review Manager version 5.4.1. A total of 20 studies were identified. The results showed that in patients with telogen effluvium, including those with acute and chronic telogen effluvium, serum iron and serum ferritin levels were lower than those in the normal population. There was no significant difference in serum ferritin and iron levels between patients with acute and chronic telogen effluvium. In patients with chronic telogen effluvium, the prevalence of ferritin deficiency was higher than that in the general population when ferritin levels were 20 ng/dl and 30 ng/dl as the threshold for the diagnosis of iron deficiency. This meta-analysis revealed that iron deficiency is associated with telogen effluvium and clarified the critical serum ferritin level for defining iron deficiency in patients with telogen effluvium.
... diverse, relating to depletion of cellular iron function in multiple tissue types, and exist long before prolonged iron deficiency restricts haemoglobin synthesis in the bone marrow and anaemia develops. While there is overlap in the common symptoms of iron deficiency and anaemia: fatigue, lethargy, dizziness, and shortness of breath; the symptoms of loss of concentration, headaches and easy bruising are more indicative of iron deficiency and a few symptoms are highly specific to iron deficiency such as restless leg syndrome, hair loss or pica (inexplicable eating of ice, paper or dirt)[27][28][29].To assess the range and prevalence of symptoms experienced by women with iron deficiency[30] we undertook a consumer involvement exercise through social media. Initially, a poll was developed to ask women about their symptoms in their own words. ...
Article
Full-text available
Anaemia is common, particularly in women and the commonest underlying cause, iron deficiency, is often overlooked. Anaemia is associated with increased morbidity and mortality in patients undergoing anaesthesia; however, women are defined as being anaemic at a lower haemoglobin level than men. In this narrative review, we present the history of iron deficiency anaemia and how women’s health has often been overlooked. Iron deficiency was first described as ‘chlorosis’ and a cause of ‘hysteria’ in women and initial treatment was by iron filings in cold wine. We present data of population screening demonstrating how common iron deficiency is, affecting 12–18% of apparently ‘fit and healthy’ women, with the most common cause being heavy menstrual bleeding; both conditions being often unrecognised. We describe a range of symptoms reported by women, that vary from fatigue to brain fog, hair loss and eating ice. We also describe experiments exploring the physical impact of iron deficiency, showing that reduced exercise performance is related to iron deficiency independent of haemoglobin concentration, as well as the impact of iron supplementation in women improving oxygen consumption and fitness. Overall, we demonstrate the need to single out women and investigate iron deficiency rather than accept the dogma of normality and differential treatment; this is to say, the need to change the current standard of care for women undergoing anaesthesia.
... The development of alopecia has been associated with iron deficiency in humans [67] and was also found in mice with altered expression of proteins of iron metabolism [68][69][70], although in these settings it has not been possible to distinguish the relative contribution of systemic iron deficiency/anemia vs. local iron availability. We have recently shown that genetic deletion of FPN in macrophages resulted in skin lesions and transient alopecia due to impaired proliferation in rapidly growing cells of the hair follicle [31]. ...
Article
Full-text available
Body iron levels are regulated by hepcidin, a liver-derived peptide that exerts its function by controlling the presence of ferroportin (FPN), the sole cellular iron exporter, on the cell surface. Hepcidin binding leads to FPN internalization and degradation, thereby inhibiting iron release, in particular from iron-absorbing duodenal cells and macrophages involved in iron recycling. Disruption in this regulatory mechanism results in a variety of disorders associated with iron-deficiency or overload. In recent years, increasing evidence has emerged to indicate that, in addition to its role in systemic iron metabolism, FPN may play an important function in local iron control, such that its dysregulation may lead to tissue damage despite unaltered systemic iron homeostasis. In this review, we focus on recent discoveries to discuss the role of FPN-mediated iron export in the microenvironment under both physiological and pathological conditions.
... They are a marker of storage of iron and when iron reserves go down serum ferritin is also decreases. [11][12][13][14] Though studies have not established relationship between iron deficiency and hair loss, the intention of present study is to evaluate relationship between iron and hairloss. [15][16][17][18][19] At this scenario, our study was planned to find factors determining hair loss and measurement of iron parameters. ...
Article
Full-text available
p class="abstract"> Background: Among all the nutritional causes of hair loss, iron levels are found to be important key nutrient. Synthesis of hair involves many steps which require iron as a cofactor. The intention of present study is to evaluate relationship between iron and hair loss. The objectives of the study are to study the clinical patterns, demographic and epidemiological factors associated with hair loss and to find association between iron study parameter (Hb, serum iron, serum ferritin, TIBC) and hair loss. Methods: The study was a cross section- observational study, conducted among the patients with diagnosed non-cicatricial alopecias from June 2018 to April 2019. A total of 50 study participants were recruited. Specific investigations like hair pull test and trichogram were done. Chi square test was applied and p<0.05 was considered significant. Results: Among the total 50 participants 35 (70%) were males and 15 (30%) were females. Mean (±SD) age was 44 (±9.5) years. Mean (SD) of haemoglobin, serum iron, TIBC and ferritin are 9.6 (±2.6), 75.5 (±50), 365 (±54) and 106 (±87) respectively. Trichogram result proves telogen hair- 22 (44%), dystrophic hair loss- 14 (28%) and anagen hair loss-14 (28%). Hair pull test was positive in 27 (54%). Higher proportion of male pattern hair loss was associated with lower haemoglobin and low serum ferritin levels. (p value -0.046, 0.031) Conclusions: Significant association was found between the diagnosis of non cicatricial alopecia and mean values of haemoglobin and serum ferritin with lower haemoglobin and low serum ferritin was mostly associated with male pattern hair loss.</p
... Several studies have also examined the relationship between ID and hair loss. Although iron supplementation is recommended for women with IDA, treatment for women with NAID seems to be more controversial [20,21]. All these symptoms can potentially manifest in menstruating women with NAID, but some women with NAID will not suffer from any of them. ...
Article
Full-text available
To register all symptoms reported by non-anemic menstruating women, and examine the links between these symptoms and iron status parameters available including serum ferritin (SF) in primary care. In this cross-sectional study, we collected clinical and biological data from 780 French menstruating women aged 18–50 years. The data included an anonymous questionnaire (biometric information, physical and cognitive symptoms, reduction in physical performance, current quality of life with SF-36 questionnaire) and seven biological parameters available in primary care. We excluded women with anemia (hemoglobin < 12 g/dl) or chronic disease. Correlations were studied for 554 participants in bivariate analysis (BVA) and multivariate analysis (MVA), with adjusted odds ratio (OR). Receiver operating characteristic (ROC) curves were established for significant correlations in MVA (p < 0.05). Among these 554 non-anemic women included, 304 (54.9%) had SF level below 50 µg/l, 103 (18.6%) had SF level below 20 µg/l, and 60 (10.8%) had SF level below 15 µg/l. Iron deficiency was significantly correlated with recent hair loss for SF ≤ 15 µg/l (OR = 2.19 with p = 0.02 in MVA) and SF ≤ 20 µg/l (OR = 2.26 with p < 0.01 in MVA). SF ≤ 20 µg/l was also correlated with limitations due to emotional problems according to SF-36 questionnaire (p = 0.01 in MVA). SF ≤ 50 µg/l was significantly correlated with restless legs syndrome (OR = 2.82 with p = 0.01 in MVA). Only one ROC curve for restless legs syndrome could suggest an optimal SF cut-off point at 39 µg/l (sensitivity 73%, specificity 61%). We identified two symptoms significantly more reported by non-anemic iron-deficient menstruating women: recent hair loss for serum ferritin (SF) ≤ 20 µg/l and restless legs syndrome for SF ≤ 50 µg/l. Non-anemic iron deficiency may also impact their quality of life, but further investigation is needed. If one of these symptoms is reported in primary care, the possibility of a symptomatic iron deficiency cannot be ruled out, and iron supplementation should be considered.
... However, serum ferritin levels from 20-60 ng/ml may require treatment. It has been recommended by few authors that maintaining serum ferritin levels of more than 40 ng/mL or 70 ng/mL would help reverse severe hair loss due to TE (Telogen Effluvium) as ferritin levels less than 40 ng/ml as well as levels between 40 ng/ml and 70 ng/ml have been highly associated with telogen hair loss in previous studies [15,16]. ...
Article
Full-text available
Objective: To investigate the role of vitamins, minerals, and hormones in the pathogenesis of hair loss in young women between the ages 20-30 years old. Methods: We conducted a study based on young women who were referred to the Royal Wolverhampton NHS Trust, Wolverhampton (secondary care hospital) with hair loss and were investigated by Results: 15 out of 16 patients (93.75 %) of all the female patients who presented with alopecia were investigated and found to be deficient of Vitamin D. 16 out of 17 patients were investigated for Zinc Levels. 7 out of 17 patients (43.7%) were found to have low zinc Levels and 2 out of the 3 patients with irregular periods were noted to have low SHBG levels (66.6%). 10 out of 16 patients (62%) were found to have abnormal ferritin levels (<20 ng/ml) and 6 out of the 17 patients (35.2%) were found to have low haemoglobin levels. Conclusion: Results from this study highlight the importance of early investigating the levels of vitamins, minerals and hormones in young women who present with alopecia and the need to conduct these blood tests as part of the routine treatment at primary care level. Volume 5 | Issue 1 | 1
... 43 Reflecting bleeding symptoms, 38,42,44 anemia is more common with advanced age. Iron deficiency anemia in HHT results in typical signs and symptoms, including fatigue, reduced exercise tolerance, pica, restless leg syndrome, hair loss, and others, [45][46][47][48] and may considerably worsen symptoms of high-output cardiac failure in patients with significant liver AVMs. 29,31 Anemia was not a priority topic area in the initial HHT guidelines 9 and was included as such in the second guidelines in part IV bevacizumab is given as induction (5 mg/kg every 2 weeks for 4-6 doses) followed by maintenance (dosing variable; 5 mg/kg every 1-3 months is an option). ...
Article
Hereditary hemorrhagic telangiectasia (HHT) management is evolving due to the emergence and development of antiangiogenic therapies to eliminate bleeding telangiectasias and achieve hemostasis. This is reflected in recent clinical recommendations published in the Second International Guidelines for the Diagnosis and Treatment of HHT, in which systemic therapies including antiangiogenics and antifibrinolytics are now recommended as standard treatment options for bleeding. This review highlights the new recommendations especially relevant to hematologists in managing bleeding, anticoagulation, and anemia in patients with HHT.
... However, there is insufficient data in AA to urge iron deficiency screening. One limitation of studies on iron insufficiency is the predominance of female patients [160,161]. ...
Article
Full-text available
Immune-mediated inflammatory skin diseases are characterized by a complex multifactorial etiology, in which genetic and environmental factors interact both in genesis and development of the disease. Nutrition is a complex and fascinating scenario, whose pivotal role in induction, exacerbation, or amelioration of several human diseases has already been well documented. However, owing to the complexity of immune-mediated skin disease clinical course and breadth and variability of human nutrition, their correlation still remains an open debate in literature. It is therefore important for dermatologists to be aware about the scientific basis linking nutrition to inflammatory skin diseases such as psoriasis, atopic dermatitis, hidradenitis suppurativa, bullous diseases, vitiligo, and alopecia areata, and whether changes in diet can influence the clinical course of these diseases. The purpose of this narrative review is to address the role of nutrition in immune-mediated inflammatory skin diseases, in light of the most recent and validate knowledge on this topic. Moreover, whether specific dietary modifications could provide meaningful implementation in planning a therapeutic strategy for patients is evaluated, in accordance with regenerative medicine precepts, a healing-oriented medicine that considers the whole person, including all aspects of the lifestyle.
... An association between iron deficiency and hair loss has been recognized for some time, but the mechanisms involved are poorly understood (Trost et al. 2006;Almohanna et al. 2019). The MCFs may play an important role in hair development as disruption of either HEPH or ZP has been associated with an abnormal hair phenotype. ...
Article
Full-text available
The mammalian multicopper ferroxidases (MCFs) ceruloplasmin (CP), hephaestin (HEPH) and zyklopen (ZP) comprise a family of conserved enzymes that are essential for body iron homeostasis. Each of these enzymes contains six biosynthetically incorporated copper atoms which act as intermediate electron acceptors, and the oxidation of iron is associated with the four electron reduction of dioxygen to generate two water molecules. CP occurs in both a secreted and GPI-linked (membrane-bound) form, while HEPH and ZP each contain a single C-terminal transmembrane domain. These enzymes function to ensure the efficient oxidation of iron so that it can be effectively released from tissues via the iron export protein ferroportin and subsequently bound to the iron carrier protein transferrin in the blood. CP is particularly important in facilitating iron release from the liver and central nervous system, HEPH is the major MCF in the small intestine and is critical for dietary iron absorption, and ZP is important for normal hair development. CP and HEPH (and possibly ZP) function in multiple tissues. These proteins also play other (non-iron-related) physiological roles, but many of these are ill-defined. In addition to disrupting iron homeostasis, MCF dysfunction perturbs neurological and immune function, alters cancer susceptibility, and causes hair loss, but, despite their importance, how MCFs co-ordinately maintain body iron homeostasis and perform other functions remains incompletely understood.
... [2,17,18] Emotional trauma of a family death or an accident have been reported as precipitating factors in individual cases, but there are no controlled studies proving this. Iron deficiency was noted in 24-71% of females with AA. [19] AA was less frequently observed in people, taking diet rich in soy oil. [20] Cytomegalovirus infections and hepatitis B vaccination were implicated, but further studies failed to confirm any correlation. ...
... Possible mechanisms for the participation of iron in the AGA pathogenesis include limitation of the availability of both the iron-dependent cofactor ribonucleotide reductase (an enzyme restricts the rate of DNA synthesis and, consequently, the proliferation of cells) and irondependent coenzymes of stearyl coenzyme A desaturase which provides the formation of polyene fatty acids necessary for adequate transmembrane transport and cells response to regulatory molecules [36]. Since the cells of the hair follicle matrix are one of the fastest dividing cells in the body, they can be extremely sensitive even to a slight decrease in Fe availability which leads to decrease in hair growth in the presence of Fe deficiency [39]. ...
Article
Full-text available
Androgenetic alopecia (AGA) is the most common variant of male pattern baldness in which occurrence and development of multiple genetic, hormonal, and metabolic factors are involved. We aimed to estimate plasma element content (Mg, Ca, Zn, Cu, Se, Fe), vitamin status (B12, D, E, and folic acid) in patients with AGA using direct colorimetric tests or atomic absorption spectrometry, and the influence of these parameters in the formation of various hair loss patterns. The study included 50 patients with I–IV stages of AGA divided into two groups with normal and high levels of dihydrotestosterone compared with 25 healthy individuals. The presence of two patterns of pathological hair loss in the androgen-dependent (parietal) and androgen-independent (occipital) areas of the scalp was confirmed. It was shown that all patients with AGA have a deficiency of elements (Zn, Cu, Mg, Se) and vitamins (B12, E, D, folic acid). However, the hair loss rate was not due to their content. А positive interrelation between quantitative trichogram parameters in the occipital region and iron metabolism in pairs “hair density vs Fe” and “hair diameter vs ferritin” was shown. In turn, in the parietal region, an inverse correlation of hair diameter with plasma Cu level was found, the most pronouncing in patients with high levels of dihydrotestosterone. The obtained results indicate the importance of multiple micronutrient deficiencies in the AGA occurrence accompanied by the existence of two different hair loss patterns, differently related to the content of certain trace elements and androgens in the blood.
... Controlled studies regarding the effectiveness of iron therapy on the result of TE are also deficit, although some benefit has been claimed (3) . It has been suggested that maintaining serum ferritin above 40 ng/dL (12) (70 ng/dl by some authors (13) helps reverse hair loss. An adequate dietary intake and, if required, ferrous sulfate orally at does 300 mg (60 mg elemental iron) taken 3-4 times daily is a broadly consent and cost effective initial therapy (14,15,16) .It should lead to rise in hemoglobin concentration by 2 g/dL in 3-4 weeks (16,17) . ...
Article
Full-text available
Back ground : Diffuse hair loss is a very common complaint usually occurs without inflammation or scarring .The loss affects hairs throughout the scalp in a more or less uniform pattern. That is characterized by the ingress of a large number of hairs prematurely into telogen phase resulting in diffuse hair shedding at one time often with an acute onset so named acute telogen effluvium .A chronic form with a more insidious onset and a longer duration also exists called chronic telogen effluvium which primarily affects women between the ages of 30 and 60 years and is a diagnosis of exclusion and can cause a great psychological impact on the life of the affected person. Objective: Measurement the level of serum ferritin and the level of serum vitamin D In adult females with chronic telogen effluvium in order to validate their role in the process of hair loss. Patients& Methods : This cross-sectional study was conducted at the outpatient Department of Dermatology and Venereology in Al-kindy Teaching Hospital between March and November 2017.Sixty adult Female at age (12 to 52 years) with hair loss in the form of CTE otherwise they are healthy and sixty adult healthy with same age-matched female with no hair loss were included in the study. Diagnosis was based upon clinical examination as well as hair pull test. Serum ferritin and vitamin D levels and Hemoglobin were determined for each participant. Results : Hair loss can have an emotional impact on patients leading to anxiety and frustration. Therefore, diagnosing the underlying etiology is necessary for the better management of the disorder The results of this study suggest that the reduced hair density seen in CTE may possibly be associated with low serum levels of ferritin and vitamin D. It is recommended that hemoglobin level measurement should not be solely relied on in the assessment of hair loss, as it was not significantly different between patients with CTE and controls as seen in our study. Conclusions: The female cases in this study had significantly low levels of serum ferritin and vitamin D than controls .Our study highlights the importance of serum ferritin and vitamin D evaluation in case of diffuse hair fall.
... In severe anemia due to iron deficiency, pallor, tachycardia and low blood pressure are expected in the skin and conjunctiva. Coilonia, glossitis and angular stomatitis are among the skin findings seen in iron deficiency anemia (37). Hair loss is in the 4th place among skin problems in this study. ...
Article
Full-text available
Objective: To investigate the nutritional habits of the 14-25 years old people with skin problems. Design: We performed a cross-sectional study with random sampling of participants. Skin problems was questioned with questionnaire form. Last three days food consumption was recorded and food consumption frequencies were questioned. Also anthropometric measurements were taken. Setting: A state university and two high school in Samsun, Turkey. Subjects: Students (n =400) aged between 14-25 years. Results: Among students, 251 were women and 149 men. 219 of them have skin problems and 181 didn't have any skin problems. Mean BMI (body mass index) of students was 20.95±2.67 kg/ in women and 22.65±3.17 kg/ in men. Mean body mass index in students with skin problem (SP) was 21.55 ± 2.91 kg/m 2 and without SP was 21.61±3.07 kg/. Among students who have SP problems (n = 219), acne (35.2%) was the first skin problem. Gender, sleep duration, physical activity, frequency of eating out, consumption of tea with food, french fries consumption, daily water intake amount had a significant difference on skin problems (p<0.05). More skin problems were found in individuals eating patisseries (p<0.05). Those who not have skin problems were found to consume more milk, yogurt, buttermilk and mineral water (p<0.05). Conclusions: In this study, it was showed that skin problems could be affected by environmental and personal properties. In order to establish a relationship between these problems and nutrition these properties should be examined. There is not enough research on this subject and another randomized controlled trials are needed to determine the relationship.
... In modern medicine, the reduction in hemoglobin is commonly considered as blood deficiency, including aplastic anemia, iron deficiency anemia and blood loss anemia [19]. However, blood loss anemia is more similar to the condition of postoperative and postpartum women, with uterine bleeding or chronic bleeding [20]. ...
Article
Full-text available
Maoji Jiu (MJ) is a kind of medicinal wine that has been widely used by Chinese people for many years to nourish and promote blood circulation. The purpose of this study was to investigate the hematopoietic effect of MJ on the metabolism of blood deficient rats and to explore the underlying hematopoietic regulation mechanisms. Blood deficiency model rats were induced by subcutaneous injection of N-acetylphenylhydrazine (APH) and intraperitoneal injection of cyclophosphamide (CTX). The plasma metabolic fingerprints of blood deficiency model rats with and without MJ treatment were obtained by using metabonomics based on ultra-high-performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UHPLC–QTOF/MS). Orthogonal partial least squares-discriminant analysis (OPLS–DA) was used to evaluate the hematopoietic effect of MJ and identify potential biomarkers in the plasma of blood deficiency model rats. The levels of white blood cells (WBC), red blood cells (RBC) and hemoglobin (HGB) and the activity of antioxidant capacity showed a recovery trend to the control group after MJ treatment, while the dose of 10 mL/kg showed the best effect. In this study, thirteen potential biomarkers were identified, which were mainly related to seven metabolic pathways, including linoleic acid metabolism, d-glutamine and d-glutamate metabolism, alanine, aspartate and glutamate metabolism, tryptophan metabolism, pyrimidine metabolism, porphyrin and chlorophyll metabolism and arginine biosynthesis. Metabolomics was applied frequently to reflect the physiological and metabolic state of organisms comprehensively, indicating that the rapid plasma metabonomics may be a potentially powerful tool to reveal the efficacy and enriching blood mechanism of MJ.
... In modern medicine, the decreased level of hemoglobin is commonly considered a blood deficiency, containing aplastic anemia, iron deficiency anemia, and blood loss anemia [14]. It was shown that the blood deficiency model induced by APH and CTX was more similar to the internal environment in blood deficiency [9]. ...
Article
Full-text available
Maoji Jiu (MJ), a medicinal wine, has been used commonly by the Chinese to enrich and nourish the blood. In this study, the aim is to examine the hematopoietic function of MJ and investigate its hematopoietic regulation mechanism. Thirty-six female Sprague-Dawley rats (200 ± 20 g) were randomly divided into six groups with six rats in each group. The blood deficiency model was induced by injecting hypodermically with N-acetylphenylhydrazine (APH) and injecting intraperitoneally with cyclophosphamide (CTX), and treatment drugs were given by oral gavage twice a day for continuous 10 days from the start of the experiments. The administration of MJ improved the levels of white blood cells (WBCs), red blood cells (RBCs), hemoglobin (HGB), and hematocrit (HCT) in the blood deficiency model rats. Hematopoietic effect involves regulating the antioxidant activity in the liver and the levels of Bcl-2, Bax, erythropoietin (EPO), transforming growth factor-beta-1 (TGF-β1), and macrophage colony-stimulating factor (M-CSF) mRNA in spleen tissues to enhance extramedullary hematopoiesis. This study suggests that MJ has a beneficial effect on blood deficiency model rats.
... Iron deficiency is the world's most common nutritional deficiency and has been shown to be a risk factor for hair loss in non-menopausal women [6] and koilonychia in some cases (spoon-shaped nails) [5]. Although the role of iron in hair loss is not clear, serum ferritin concentration has been shown to be lower in females with patterned hair loss [7] and treatment for hair loss has been shown to be enhanced when iron deficiency, with or without anaemia, is treated [8]. The trace elements zinc and copper play a role in hair loss and growth [9]. ...
Article
Full-text available
Deficiency of micronutrients may represent a modifiable risk factor associated with the development, prevention, and treatment of decreased hair and nail quality or hair loss. The aim of this monocentric, single-arm intervention study was therefore to investigate whether taking a food supplement with a rational composition of components affects hair and nail quality in women. A validated and non-invasive tool, the Trichoscale® method, was used to quantify hair loss / hair growth. Subjective evaluation of hair and nail quality was also carried out by subjects and experts using a questionnaire. Intake of the dietary supplement resulted in significant improvement in hair status in several key parameters. The number of hairs in the growth phase significantly increased when compared to baseline (+7.5% after 8 weeks, +10.7% after 16 weeks), as did the density of adult fully pigmented hairs per square centimetre (+2.6% after 8 weeks; +5.9% after 16 weeks). Hair and nail quality improved significantly according to both the self-evaluation of the female participants and the assessment by a dermatological expert. The results of the Trichoscale® method and subjective evaluations consistently demonstrated the beneficial effects of a food supplement on hair growth and nail quality in women.
... Some studies have demonstrated that various genes in the hair follicle are regulated by iron [71]. Iron deficiency, which also causes telogen effluvium, is the most frequent dietary deficiency worldwide [72,73]. The level of serum ferritin, also known as iron-binding protein, is an important correlate of total body iron stores and is utilized in hair loss research as an indicator. ...
Article
Full-text available
Hair loss is a widespread concern in dermatology clinics, affecting both men's and women's quality of life. Hair loss can have many different causes, which are critical to identify in order to provide appropriate treatment. Hair loss can happen due to many variables, such as genetic factors or predisposition, vitamin and mineral deficiencies, skin problems, hair growth disorders, poor diet, hormonal problems, certain internal diseases, drug use, stress and depression, cosmetic factors, childbirth, and the che-motherapy process. Treatment for hair loss varies depending on the type of alopecia, deficiency, or excess of structures such as vitamins and minerals, and also on hair and skin structure. The Mediterranean diet is characterized by low amounts of saturated fat, animal protein, and high amounts of unsatu-rated fat, fiber, polyphenols, and antioxidants. The main nutrients found in the Mediterranean Diet are rich in antioxidant, anti-inflammatory components. It also has an important place in hair loss treatment, since recently treatment strategies have included polyphenols and unsaturated oils more and more frequently. The goal of this work was to review published articles examining alopecia and its types, the many micronutrients that affect alopecia, and the role of the Mediterranean diet in alo-pecia. The literature shows that little is known about hair loss, nutritional factors, and diet, and that the data collected are conflicting. Given these differences, research into the function of diet and nutrition in the treatment of baldness is a dynamic and growing topic.
... The most common causes of iron deficiency are menstrual blood loss and pregnancy in premenopausal women. 10 ...
Article
Full-text available
Iron deficiency leads to disruption of hair follicle as elemental Iron is involved in various physiological processes within the hair follicle. The aim of this study is to evaluate if a correlation exists between decreased serum ferritin levels and the most common causes of diffuse hair fall.' This was a cross sectional study conducted at a teaching hospital and research center. 60 female patients aged between 15-45 years complaining of diffuse hair loss are taken into consideration. A significant correlation was found between decreased body iron stores (as measured by serum ferritin levels) and diffuse hair loss. 65% of the subjects were found to be in iron deficient state, 20% in iron depleted state, 8.33% with adequate serum ferritin levels but lower than the required for normal hair cycle, and 3.66% with normal ferritin levels. Diffuse hair loss was found to be associated with significantly decreased serum ferritin levels.
Chapter
For millenia the existence of hereditary hemorrhagic disorders has been known. Only in the last century has hereditary hemorrhagic telangiectasia (HHT) been separated from the various types of hemophilia based on the unique clinical manifestations of HHT. Drs. Henri Rendu and William Osler, as well as others, pointed out the characteristics of its hemorrhage and genetic transmission as well as the absence of excessive hemorrhage from surgery or trauma. Laboratory studies of blood indicated that the defect of HHT was not in the blood itself but in hereditary defects in the structure and function of the microcirculation. Therapeutic advances now include new effective treatments with antiangiogenic agents such as bevacizumab. Additionally, aggressive preemptive replenishment of iron has minimized the role of chronic blood transfusions and their serious side effects. Multispecialty units of the HHT Centers of Excellence offer modern genetic testing and counselling, cutting-edge advancements in treatment, participation in therapeutic studies, and access to specialized invasive and surgical procedures.
Chapter
The quantity and quality of hair are closely related to the nutritional state of an individual. In instances of protein and calorie malnutrition, deficiency of essential amino acids, of trace elements, and of vitamins, hair growth and pigmentation may be perturbed. The effects of nutrition on hair growth and pigmentation have been recognized from observations in rare inborn errors of metabolism of copper (Menkes kinky hair syndrome), zinc (acrodermatitis enteropathica), biotin (biotinidase and holocarboxylase synthetase deficiency), and amino acids (homocystinuria, Hartnup disease, phenylketonuria, and methionine malabsorption syndrome), in specific acquired deficiency disorders, and from the respective supplementation studies. All vitamins were identified by 1948, ushering in a half century of discovery focused on single-nutrient-deficiency diseases. The first half of the twentieth century witnessed the identification and synthesis of many of the known essential vitamins and minerals and their use to prevent and treat nutritional deficiency-related diseases, specifically protein-calorie malnutrition, deficiencies of biotin, vitamin C, vitamin B12, niacin, essential fatty acids, iron, zinc, copper, selenium, and vitamin D. Accelerating economic development and modernization of agricultural, food processing, and food formulation techniques continued to reduce single-nutrient-deficiency diseases globally. In response, nutrition science shifted to the research on the role of nutrition in more complex conditions, such as gluten sensitivity, obesity, bariatric surgery, anorexia and bulimia, alcoholism, aging, and the oncologic patient. Additional complexity may arise in nutritional recommendations for general well-being versus treatment of specific conditions. Recognition of complexity is a key lesson of the past. Initial observations lead to reasonable, simplified theories that achieve certain practical benefits, which are then inevitably advanced by new knowledge and recognition of ever-increasing complexity.
Chapter
Pediatric gastroenterology practitioners adopted different guidelines that focus on high-quality nutrition care for rare disorders such as inflammatory bowel disease in its two main forms: Crohn's disease and ulcerative colitis. This chapter presents a case report of ulcerative colitis with extra intestinal manifestations in the form of right knee arthritis and hypo-chromic microcytic anemia in a 13 years old Egyptian boy who presented to the outpatient services with complains of frequent attacks of right knee pain and swelling, nausea, decreased appetite and food intake, along with significant weight loss. Attacks of diarrhea associated with abdominal cramping and progressive fatigue was reported at the first visit. The authors of this case chapter aimed to share their experience in diagnosing, managing and systematically follow up a pediatric ulcerative colitis patient. The chapter refers to a comprehensive management of the patient's disease who was effectively managed by an integrated multidisciplinary approach.
Article
The article is of a review nature and contains up-to-date information on modern attitudes, causes, trigger factors, classification, diagnostics and treatment methods of telogen effluvium. It gives the data on the use of hardware lighting technologies for hair loss treatment.
Article
Full-text available
The problem of androgenetic alopecia in women is considered by experts of various specialties, however there are few reviews about metabolic processes in these patients. Objective: to increase the efficiency of treatment of androgenetic alopecia in view of metabolic abnormalities. Material and methods. 80 female patients with androgenetic alopecia were examined to identify the features of the clinical course and hormonal metabolic deviations. Results. It was found that women with the androgenetic alopecia have abnormalities in carbohydrate and lipid metabolism in the majority of cases. Combined therapy with metformin helped to increase the clinical efficacy in the treatment of women with androgenetic alopecia.
Chapter
Androgenetic alopecia (AGA) remains the most common etiology of hair loss as it affects up to 50% of men and women over the age of 40 years. Despite its prevalence, the FDA has currently approved only three medical treatments for AGA, including topical minoxidil, oral finasteride, and most recently, low-level laser therapy (LLLT). Although supported by less robust studies, other evidenced-based, off-label treatments available in the United States include oral dutasteride, oral flutamide, oral spironolactone, oral minoxidil, topical ketoconazole, and topical latanoprost. This chapter subsequently discusses the mechanism of action, indication, efficacy, adverse events profile, dosing, administration, and other considerations for both FDA and non-FDA-approved medical treatments for AGA.
Article
Eyebrows and eyelashes serve important anatomical and social functions, and hair loss at these sites can impact patients significantly. Acquired eyebrow and eyelash loss (madarosis) may be due to a variety of underlying local or systemic disease processes; in other cases it may be idiopathic. There is a dearth of literature relating to eyebrow and eyelash loss, and there is limited guidance to help clinicians treat these clinical presentations in comparison with scalp alopecia. Here, we discuss the acquired causes of eyebrow and eyelash alopecia, our clinical approach to diagnosis and review treatment options for clinicians.
Article
Full-text available
Background and objective: Iron deficiency is a well-documented cause of diffuse non-scarring hair loss. We aimed to find the best representative laboratory parameter for iron deficiency. Methods:This was a cross-sectional observational study conducted on 51 female patients with diffuse non-scarring hair loss and iron deficiency state. Iron deficiency was diagnosed as serum ferritin below 30 ng/ml, TSAT below 20% or CHr below 29 pg. Results: Among 51 female patients with diffuse non-scarring hair loss with laboratory proven iron deficiency; low CHrwas reported in 50 (98%) patients, low TSAT was reported in 43 (84.3%) patients, low serum ferritin was reported in 28 (55%). Conclusion:The reticulocyte hemoglobin content (CHr) shows the highest frequency of iron deficiency in patients with diffuse hair loss and iron deficiency state.
Article
An anthracene-quinoline based dual-mode chemosensor, anthracene-9-carboxylic acid quinoline-8-ylamide (HAQ), has been synthesized and fully characterized by elemental analyses, different spectroscopic methods, and single crystal X-ray diffraction. HAQ acts as “On-Off”...
Article
Side effects of nutritional supplements, Edited by F. Anselmo, M.S. Driscoll Where on earth did the copy editor decide to do this?Abstract Vitamin and mineral supplement consumption is widespread. They are taken for a variety of conditions, including dermatologic disorders. Although consumers often assume these supplements are safe, excessive consumption of supplements may have deleterious effects. Such vitamin supplements include vitamin A, niacin, biotin, vitamin D, and vitamin E, and specific mineral supplements include zinc, copper, and iron. These supplements may have a number of potential adverse effects.
Article
delete Edited by K O'Connor, L J Golderg Healthy hair results from a combination of good generalized health and mindful health care practices. Many nutritional deficiencies lead to poor hair health and include changes to hair structure, texture, and viability. Although the mechanisms by which individual nutrients contribute to hair growth and maintenance have yet to be fully resolved, there are a variety of risk factors that predispose an individual to a nutritional deficiency; age, malnutrition, malabsorption, and medication use are among the most common. A thorough history should be taken in a patient with a hair disturbance to identify risk factors for a nutritional deficiency, which will then guide directed laboratory testing and treatment.
Conference Paper
Full-text available
This book contains information obtained from authentic and highly regarded sources. This is an edition made for publication of the works resulting from the ICHWBI2019 which are available individually on ©WORK journal website, where the reader will find a significant heterogeneity. Abstracts are ongoing or completed project-based research papers submitted by researchers from various academic degrees. This diversity is also found in the authors' scientific areas, reflecting on the variety of research themes presented at the Congress itself. Reasonable effort has been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use.
Article
Objective To review the literature on valproate-associated hair abnormalities and the available treatment options. Methods We searched PubMed and Google Scholar with keywords including “valproate”, “valproic acid”, “hair”, “alopecia”, and “effluvium,” supplemented with hand search from cross-references. We included all types of studies including case reports in this review. Results The pathophysiology of hair loss includes telogen effluvium, biotin, mineral deficiency, and possibly hyperandrogenism. Diagnosis is based on history of hair loss or abnormalities following valproate treatment, and is confirmed by use of simple clinical tests such as pull test and modified wash test. Treatment involves reassurance and advice on hair care, and if possible drug discontinuation or dose reduction. Medications such as biotin and other vitamins with minerals supplementation is effective for most individuals with hair loss. Other treatment options are agomelatine, topical valproate or minoxidil, though these lack evidence. Conclusion Hair abnormalities with valproate are common, benign adverse effects, and management includes general measures and specific treatment options.
Chapter
The impact of aging on the integrity of the outermost layer of our tissue, the epithelium, predisposes the older adult to dysfunction in these tissues found in the skin, lungs, eyes, and hair. As the foundation of health, the health status of the gut lining directs the status of other epithelial tissues due to the impact of nutritional deficiencies from malabsorption as well as the impact of the microbiome that exists on all of these external-facing surfaces. Both environments, the skin and the gut, host microbiomes of immense and diverse proportions. On its own, the gut performs innumerable functions, including but not limited to vitamin production, immune regulation, protection from pathogens, serum lipid modulation, and metabolism of xenobiotics and food components (Ellis et al. Microorganisms 7:550, 2019). The skin serves to maintain the cutaneous immune system. (Ellis et al. Microorganisms 7:550, 2019). Although the mechanisms are not fully elucidated, there are a few prevailing theories. Changes in gut flora due to stress, injury, or inflammation increase epithelial permeability in the gut, which triggers T-cell activation, disrupts tolerance, and leads to systemic inflammation that disturbs cutaneous homeostasis (Arck et al. Exp Dermatol 19:401–5, 2010). Another theory suggests increased gut permeability allows for direct migration of inflammatory products into systemic circulation (Cani et al. Diabetes 56:1761–72, 2007). The connection warrants further research but is likely due to a combination of both neurologic and immunologic responses to environmental changes (Ellis et al. Microorganisms 7:550, 2019). In this chapter, we highlight the most common concerns related to the skin, lungs, eyes, and hair for the older adult: xerosis, psoriasis, eczema, chronic obstructive pulmonary disease, macular degeneration, and alopecia.
Chapter
Iron is a chemical element with the symbol Fe and atomic number 26. It is the most common element on Earth by mass, forming most of Earth’s outer and inner core. Iron is an essential trace element and the most important transition metal found in all living organisms (archaeans, bacteria, and eukaryotes), including humans [1]. Iron is the primary inorganic component of hemoglobin and various other Iron-containing proteins and enzymes, some of which contain heme prosthetic groups, such as cytochrome and catalase [2].
Chapter
Diagnosis of AGA and FPHL is mostly a matter of knowledge, common sense and practice, Only rarely, will further examination be required to exclude other disorders affecting scalp and/or hair, depending on the patient’s medical history and clinical assessment.
Chapter
Pediatric gastroenterology practitioners adopted different guidelines that focus on high-quality nutrition care for rare disorders such as inflammatory bowel disease in its two main forms: Crohn's disease and ulcerative colitis. This chapter presents a case report of ulcerative colitis with extra intestinal manifestations in the form of right knee arthritis and hypo-chromic microcytic anemia in a 13 years old Egyptian boy who presented to the outpatient services with complains of frequent attacks of right knee pain and swelling, nausea, decreased appetite and food intake, along with significant weight loss. Attacks of diarrhea associated with abdominal cramping and progressive fatigue was reported at the first visit. The authors of this case chapter aimed to share their experience in diagnosing, managing and systematically follow up a pediatric ulcerative colitis patient. The chapter refers to a comprehensive management of the patient's disease who was effectively managed by an integrated multidisciplinary approach.
Article
Management of bleeding in hereditary hemorrhagic telangiectasia (HHT), the second most common hereditary bleeding disorder in the world, is currently undergoing a paradigm shift. Disease-modifying antiangiogenic therapies capable of achieving durable hemostasis via inducing telangiectasia regression have emerged as a highly effective and safe modality to treat epistaxis and gastrointestinal bleeding in HHT. While evidence to date is incomplete and additional studies are ongoing, patients presently in need are being treated with antiangiogenic agents off-label. Intravenous bevacizumab, oral pazopanib, and oral thalidomide are the three targeted primary angiogenesis inhibitors, with multiple studies describing both reassuring safety and impressive effectiveness in the treatment of moderate-to-severe HHT-associated bleeding. However, at present there is a paucity of guidance in the literature, including the published HHT guidelines, addressing the practical aspects of antiangiogenic therapy for HHT in clinical practice. This review article and practical evidence-based guide aims to fill this unaddressed need, synthesizing published data on the use of antiangiogenic agents in HHT, relevant data for their use outside of HHT, and expert guidance where evidence is lacking. After a brief review of principles of bleeding therapy in HHT, guidance on hematologic support with iron and blood products, and alternatives to antiangiogenic therapy, this article examines each of the aforementioned antiangiogenic agents in detail, including patient selection, initiation, monitoring, toxicity management, and discontinuation. With proper, educated use of antiangiogenic therapies in HHT, patients with even the most severe bleeding manifestations can achieve durable hemostasis with minimal side-effects, dramatically improving health-related quality of life and potentially altering the disease course.
Article
Full-text available
Hair fall from the scalp is a common complaint by females attending a dermatologist’s out-patient clinic. The most common cause is telogen effluvium and the most common pattern is chronic diffuse non-scarring hair fall from the scalp. The aim of our study was to analyze deficiency status and correlate hemoglobin, ferritin, cobalamin, folic acid in females of reproductive age group. This is a descriptive study was conducted in the DVL department of a tertiary care medical college hospital between 2018-2019. Clinical and demographic data were collected and hemoglobin, ferritin, cobalamin, folic acid levels were investigated. A total of 85 patients were studied. Mean Hemoglobin was found at 11.92 g/dl and Anemia was recorded at 59.32%. Ferritin levels were lower than normal in 90% of the cases. Folate levels were in the normal range in the majority of our cases. Cobalamin was deficient in 50% of our patients. Ferritin and cobalamin levels were better indicators than hemoglobin levels alone in assessing chronic nonscarring hair loss from the scalp in females of reproductive age group.
Article
Background/objectives: Telogen effluvium (TE) is a diffuse, rapidly occurring non-scarring alopecia that can be a significant source of distress for patients and caregivers. To date, the disorder has not been extensively studied in a US pediatric patient population. This study aims to characterize the epidemiology, management, and disease course of pediatric TE. Methods: A retrospective single-center analysis was conducted at the University of Miami including pediatric medical records from 2009 to 2021 with at least one clinic visit coded with the diagnosis of TE. Results: 76 patients presented with a wide range of age at onset and hair loss duration. 67% of patients (n = 51) had an identified trigger, the most common being emotional stress and acute febrile illness, followed by nutritional deficiencies (specifically iron, ferritin, and vitamin D). Observation was the most common therapeutic approach. Of patients who had a follow-up evaluation (39%), different treatments resulted in similar rates of improvement. Conclusions: The results of this study demonstrate the variability in potential TE triggers, physical exam findings, and management in children, similar to what is currently observed and practiced in adult patients. Appropriate work-up for common triggers should be included during the initial visit. Greater evidence-based treatment approaches are needed for pediatric TE.
Chapter
Hair is a defining feature of mammals. In other species hair confers important functions that affect survival. Most have been lost or are irrelevant in humans but the role of hair in social and sexual signalling in women and in men survives and thrives. Departures from cultural norms, either physiological or due to pathology, can therefore cause much concern and anxiety. Following an introduction to hair biology, this chapter considers the approach to the diagnosis and management of the patient with hair loss before discussing specific hair disorders. These include the various forms of hair loss due to hair follicle pathology, disturbances in hair cycling and hair shaft dystrophies, and disorders associated with excessive hair growth. The chapter concludes with a discussion of acquired alterations in hair pigmentation.
Article
Full-text available
object To evaluate the treatment with cyproterone acetate and ethinyl oestradlol of diffuse androgen-dependent alopecia in women design Twenty women were treated for a period of 12 months in a reverse sequential regimen employing cyproterone acetate (CPA, 50 mg once dally from Day 5 to Day 15) and ethinyl oestradlol (EE2, 30 μg once dally from Day 5 to Day 24 of the menstrual cycle), and 20 were left untreated and acted as controls. Half of each group had serum ferritin concentrations above or below 40 μg/I patients Forty Caucasian premenopausal women aged between 18 and 47 years, presenting with diffuse and rogen-dependent alopecia, were enrolled into this study measurements Hair variables were assessed initially by the unit area trlchogram and again in the same sites 12 months later. Biochemical investigations were performed before treatment and after 3, 6, and 12 months results In the treated group, a significant (P > 0·01) mean increase in total hair density (hair/cm2) and meaningful hair density (non-vellus hair/cm2) was found in patients in whom the serum ferritin was above, but not below 40 μ g/l. However, in the control group a significant (P > 0·05) mean decrease in total hair density and meaningful hair density was observed after 12 months. No correlation between serum ferritin levels and the degree of hair loss within this group could be established. conclusion Patients treated with the anti-apdrogen cyproterone acetate and ethinyl oestradlol respond best when serum ferritin is above 40 μg/I
Article
Full-text available
Iron deficiency anaemia (IDA) occurs in 2-5% of adult men and postmenopausal women in the developed world and is a common cause of referral to gastroenterologists. Gastrointestinal (GI) blood loss from colonic cancer or gastric cancer, and malabsorption in coeliac disease are the most important causes that need to be sought. DEFINING IRON DEFICIENCY ANAEMIA: The lower limit of the normal range for the laboratory performing the test should be used to define anaemia (B). Any level of anaemia should be investigated in the presence of iron deficiency (B). The lower the haemoglobin the more likely there is to be serious underlying pathology and the more urgent is the need for investigation (B). Red cell indices provide a sensitive indication of iron deficiency in the absence of chronic disease or haemoglobinopathy (A). Haemoglobin electrophoresis is recommended when microcytosis and hypochromia are present in patients of appropriate ethnic background to prevent unnecessary GI investigation (C). Serum ferritin is the most powerful test for iron deficiency (A). Upper and lower GI investigations should be considered in all postmenopausal female and all male patients where IDA has been confirmed unless there is a history of significant overt non-GI blood loss (A). All patients should be screened for coeliac disease (B). If oesophagogastroduodenoscopy (OGD) is performed as the initial GI investigation, only the presence of advanced gastric cancer or coeliac disease should deter lower GI investigation (B). In patients aged >50 or with marked anaemia or a significant family history of colorectal carcinoma, lower GI investigation should still be considered even if coeliac disease is found (B). Colonoscopy has advantages over CT colography for investigation of the lower GI tract in IDA, but either is acceptable (B). Either is preferable to barium enema, which is useful if they are not available. Further direct visualisation of the small bowel is not necessary unless there are symptoms suggestive of small bowel disease, or if the haemoglobin cannot be restored or maintained with iron therapy (B). In patients with recurrent IDA and normal OGD and colonoscopy results, Helicobacter pylori should be eradicated if present. (C). Faecal occult blood testing is of no benefit in the investigation of IDA (B). All premenopausal women with IDA should be screened for coeliac disease, but other upper and lower GI investigation should be reserved for those aged 50 years or older, those with symptoms suggesting gastrointestinal disease, and those with a strong family history of colorectal cancer (B). Upper and lower GI investigation of IDA in post-gastrectomy patients is recommended in those over 50 years of age (B). In patients with iron deficiency without anaemia, endoscopic investigation rarely detects malignancy. Such investigation should be considered in patients aged >50 after discussing the risk and potential benefit with them (C). Only postmenopausal women and men aged >50 years should have GI investigation of iron deficiency without anaemia (C). Rectal examination is seldom contributory, and, in the absence of symptoms such as rectal bleeding and tenesmus, may be postponed until colonoscopy. Urine testing for blood is important in the examination of patients with IDA (B). All patients should have iron supplementation both to correct anaemia and replenish body stores (B). Parenteral iron can be used when oral preparations are not tolerated (C). Blood transfusions should be reserved for patients with or at risk of cardiovascular instability due to the degree of their anaemia (C).
Article
Full-text available
To evaluate the treatment with cyproterone acetate and ethinyl oestradiol of diffuse androgen-dependent alopecia in women. Twenty women were treated for a period of 12 months in a reverse sequential regimen employing cyproterone acetate (CPA, 50 mg once daily from Day 5 to Day 15) and ethinyl oestradiol (EE2, 30 micrograms once daily from Day 5 to Day 24 of the menstrual cycle), and 20 were left untreated and acted as controls. Half of each group had serum ferritin concentrations above or below 40 micrograms/l. Forty Caucasian premenopausal women aged between 18 and 47 years, presenting with diffuse androgen-dependent alopecia, were enrolled into this study. Hair variables were assessed initially by the unit area trichogram and again in the same sites 12 months later. Biochemical investigations were performed before treatment and after 3, 6, and 12 months. In the treated group, a significant (P less than 0.01) mean increase in total hair density (hair/cm2) and meaningful hair density (non-vellus hair/cm2) was found in patients in whom the serum ferritin was above, but not below 40 micrograms/l. However, in the control group a significant (P less than 0.05) mean decrease in total hair density and meaningful hair density was observed after 12 months. No correlation between serum ferritin levels and the degree of hair loss within this group could be established. Patients treated with the anti-androgen cyproterone acetate and ethinyl oestradiol respond best when serum ferritin is above 40 micrograms/l.
Article
Full-text available
To determine the diagnostic values of laboratory tests used in the diagnosis of iron-deficiency anemia, the authors conducted a systematic overview of the relevant literature. Computerized searches of the MEDLINE database yielded 1,179 potentially relevant citations. Fifty-five studies included the results of laboratory tests and histologic examination of the bone marrow for at least 50% of an identifiable patient group. In these 55 studies, quality was assessed and descriptive information concerning the study populations, the tests conducted, and the results was extracted, all in duplicate. Serum ferritin radioimmunoassay was by far the most powerful test, with an area under the receiver operating characteristic curve of 0.95. Test properties differed for populations of patients with inflammatory, liver, or neoplastic disease and patients without these conditions. Likelihood ratio lines, which allow precise interpretation of results across the entire range of ferritin concentration values, were constructed for the individual populations. Serum ferritin radioimmunoassay is an extremely powerful test for the diagnosis of iron-deficiency anemia and, appropriately interpreted, can be applied to the complete range of patients.
Article
Full-text available
One hundred women who presented with diffuse alopecia, were quantitatively evaluated for hair variables and compared with 20 controls. Fifty were selected for biochemical and haematological investigations, 44 of whom also underwent endocrine evaluation. Compared to controls, significant changes in hair values were found in the frontal area of all subjects, while 84% had significant changes in the occipital area. A biphasic distribution of hair diameter was evident in subjects who had percentages of vellus hair and telogen hair less than or equal to 30 mm in length that were above the control ranges. No significant difference between the mean hormonal values of women with diffuse alopecia and controls could be found. No correlation between hair values and individual or combined hormonal levels could be established. In 18 subjects (40.9%) hormonal values were within the control ranges and these apparently normal findings were often associated with adverse hair profiles. A raised dihydrotestosterone was found in 13 subjects (29.5%) and was the most frequently elevated androgenic finding. Seventeen (34.0%) had changes in iron metabolism, while in 36 (72.0%) serum ferritin levels were below the lowest control value. All had a decrease in the percentage of hair in the anagen growth phase compared to controls. The hair changes were similar to those observed in genetic hair loss in men, a proven androgen-dependent condition. We propose that diffuse androgen-dependent alopecia is the appropriate name to describe this condition in these women.
Article
Full-text available
Recombinant epoetin therapy and correction of the chronic anemia of renal failure have greatly reduced the number of red cell transfusions and hence the propensity to iron overload. The majority of HD patients require intravenous iron therapy to achieve the hematocrit levels that correspond to improved outcome measures. Although the short-term benefits of intravenous iron have been clearly defined, the long-term risks of intravenous iron are less well-defined. Iron overload before the availability of epoetin constituted a serious problem; our review of the literature does not decisively conclude that these patients had more serious bacterial infections or increased mortality when compared with their non-iron overloaded counterparts, unless chronic transfusion-related hepatic disease was superimposed. Specifically, no data unequivocally confirm that iron overload from parenteral iron contributes to all-cause patient morbidity or mortality. Furthermore, therapy that maintains intravenous iron optimal iron stores and replaces iron losses associated with the dialytic procedure does not engender iron overload in the carefully monitored patient. Optimized anemia therapy in ESRD requires individualized and specific application of epoetin and iron for each patient, and significant cost savings can result from such a strategy. Prospective studies are clearly necessary to define those parameters that reflect adequacy of iron storage in renal failure patients. We should develop alternative means of iron delivery and develop monitors that accurately discriminate between patients who will respond to additional iron therapy and those who will not. Whether ferritin should be supplanted by another parameter and whether iron itself poses an increased risk to those patients it has so beneficially served are issues that must be resolved. Until these answers are known, the importance of carefully crafted iron therapy cannot be overstated.
Article
Full-text available
The literature reveals what little is known about nutritional factors and hair loss. What we do know emanates from studies in protein-energy malnutrition, starvation, and eating disorders. In otherwise healthy individuals, nutritional factors appear to play a role in subjects with persistent increased hair shedding. Hård, 40 years ago, demonstrated the importance of iron supplements in nonanaemic, iron-deficient women with hair loss. Serum ferritin concentrations provide a good assessment of an individual's iron status. Rushton et al. first published data showing that serum ferritin concentrations were a factor in female hair loss and, 10 years later, Kantor et al. confirmed this association. What level of serum ferritin to employ in subjects with increased hair shedding is yet to be definitively established but 70 micro g/L, with a normal erythrocyte sedimentation rate (< 10 mm/h), is recommended. The role of the essential amino acid, l-lysine in hair loss also appears to be important. Double-blind data confirmed the findings of an open study in women with increased hair shedding, where a significant proportion responded to l-lysine and iron therapy. There is no evidence to support the popular view that low serum zinc concentrations cause hair loss. Excessive intakes of nutritional supplements may actually cause hair loss and are not recommended in the absence of a proven deficiency. While nutritional factors affect the hair directly, one should not forget that they also affect the skin. In the management of subjects with hair loss, eliminating scaling problems is important as is good hair care advice and the need to explain fully the hair cycle. Many individuals reduced their shampooing frequency due to fear of losing more hair but this increases the amount seen in subsequent shampoos fuelling their fear of going bald and adversely affecting their quality of life.
Article
Full-text available
Low iron stores are considered a possible cause of chronic diffuse telogen hair loss in women. Estimation of serum ferritin is recommended as part of the initial assessment when women present with chronic diffuse telogen hair loss, and iron supplementation therapy is commonly recommended for those found to have low iron stores. To evaluate the relationship between low serum ferritin (</=20 micro g L-1) and chronic diffuse telogen hair loss in women. Between 1997 and 1999, 194 consecutive women who presented to a specialist hair clinic were assessed for diffuse telogen hair loss of greater than 6 months duration. All underwent biochemical investigations that included serum ferritin and had two 4-mm punch biopsies taken from the vertex of the scalp. One biopsy was sectioned horizontally and the other vertically. Twelve women were found to have a serum ferritin of 20 micro g L-1 or less (6.2%). Androgenetic alopecia was found on scalp biopsy in seven of these 12 women, while the other five women had normal histology. The five women with low iron stores and normal histology were treated with iron supplementation alone. This was continued until the serum ferritin was > 20 micro g L-1. Cessation or reversal of hair loss was not seen in any of these women. No direct relationship between low serum ferritin and hair loss can be established. The usefulness of serum ferritin in the routine investigation of women with chronic diffuse telogen hair loss is unclear, as is the role of iron supplementation therapy in the management of hair loss.
Article
Full-text available
Hair is considered to be a major component of an individual's general appearance. The psychological impact of hair loss results in a measurably detrimental change in self-esteem and is associated with images of reduced worth. It is not surprising that both men and women find hair loss a stressful experience. Genetic hair loss is the major problem affecting men and by the age of 50, up to 50% will be affected. Initial attempts to regenerate the lost hair have centred on applying a topical solution of between 2% to 5% minoxidil; however, the results proved disappointing. Recently, finasteride, a type II 5α reductase inhibitor has been found to regrow a noticeable amount of hair in about 40% of balding men. Further developments in treatments have lead to the use of a dual type I and type II inhibitor where 90% of those treated regrow a noticeable amount of hair. In women the major cause of hair loss before the age of 50 is nutritional, with 30% affected. Increased and persistent hair shedding (chronic telogen effluvium) and reduced hair volume are the principle changes occurring. The main cause appears to be depleted iron stores, compromised by a suboptimal intake of the essential amino acid L-lysine. Correction of these imbalances stops the excessive hair loss and returns the hair back to its former glory. However, it can take many months to redress the situation.
Article
The objective of the study was to evaluate the diagnostic efficiency of laboratory tests, including serum transferrin receptor (TfR) measurements, in the diagnosis of iron depletion. The patient population consisted of 129 consecutive anemic patients at the University Hospital of Turku who were given a bone marrow examination. Of these patients, 48 had iron deficiency anemia (IDA), 64 anemia of chronic disease (ACD), and 17 patients had depleted iron stores and an infectious or an inflammatory condition (COMBI). Depletion of iron stores was defined as a complete absence of stainable iron in the bone marrow examination. Serum TfR concentrations were elevated in the vast majority of the IDA and COMBI patients, while in the ACD patients, the levels were within the reference limits reported earlier for healthy subjects. TfR measurement thus provided a reliable diagnosis of iron deficiency anemia (AUCROC 0.98). Serum ferritin measurement also distinguished between IDA patients and ACD patients. However, the optimal decision limit for evaluation of ferritin measurements was considerably above the conventional lower reference limits, complicating the interpretation of this parameter. Calculation of the ratio TfR/log ferritin (TfR-F Index) is a way of combining TfR and ferritin results. This ratio provided an outstanding parameter for the identification of patients with depleted iron stores (AUCROC 1.00). In anemic patients, TfR measurement is a valuable noninvasive tool for the diagnosis of iron depletion, and offers an attractive alternative to more conventional laboratory tests in the detection of depleted iron stores.
Article
Iron deficiency anaemia in men and postmenopausal women is most commonly caused by gastrointestinal blood loss or malabsorption. Examination of both the upper and lower gastrointestinal tract is therefore an important part of the investigation of patients with such anaemia. In the absence of overt blood loss or any obvious cause, all patients should have upper gastrointestinal endoscopy, including small bowel biopsy, and colonoscopy or barium enema to exclude gastrointestinal malignancy. Further gastrointestinal investigation is only warranted in transfusion dependent anaemia or where there is visible blood loss. Treatment of an underlying cause will cure the anaemia but even when no cause is detected the long term outlook is good.
Article
The relationship between high dietary iron intake, mutations of the HFE gene, and iron status, and their effects on human health are reviewed. Prolonged high dietary intakes of iron are unlikely to result in iron overload in the general population. Homozygotes for the C282Y mutation of the HFE gene have elevated body iron levels. Heterozygotes have normal iron stores but some may be at increased risk for cardiovascular disease. There is no convincing evidence that elevated iron status increases the risk of coronary heart disease or type 2 diabetes, but high iron intakes may increase the risk of colorectal cancer The dietary levels of iron associated with health risks in different HFE genotypes must be determined. (C) 2003 International Life Sciences Institute.
Article
Objective. —To determine the prevalence of iron deficiency and iron deficiency anemia in the US population.Design. —Nationally representative cross-sectional health examination survey that included venous blood measurements of iron status.Main Outcome Measures. —lron deficiency, defined as having an abnormal value for at least 2 of 3 laboratory tests of iron status (erythrocyte protoporphyrin, transferrin saturation, or serum ferritin); and iron deficiency anemia, defined as iron deficiency plus low hemoglobin.Participants. —A total of 24 894 persons aged 1 year and older examined in the third National Health and Nutrition Examination Survey (1988-1994).Results. —Nine percent of toddlers aged 1 to 2 years and 9% to 11% of adolescent girls and women of childbearing age were iron deficient; of these, iron deficiency anemia was found in 3% and 2% to 5%, respectively. These prevalences correspond to approximately 700000 toddlers and 7.8 million women with iron deficiency; of these, approximately 240 000 toddlers and 3.3 million women have iron deficiency anemia. Iron deficiency occurred in no more than 7% of older children or those older than 50 years, and in no more than 1% of teenage boys and young men. Among women of childbearing age, iron deficiency was more likely in those who are minority, low income, and multiparous.Conclusion. —lron deficiency and iron deficiency anemia are still relatively common in toddlers, adolescent girls, and women of childbearing age.
Article
The relationship between high dietary iron intake, mutations of theHFE gene, and iron status, and their effects on human health are reviewed. Prolonged high dietary intakes of iron are unlikely to result in iron overload in the general population. Homozygotes for the C282Y mutation of theHFE gene have elevated body iron levels. Heterozygotes have normal iron stores but some may be at increased risk for cardiovascular disease. There is no convincing evidence that elevated iron status increases the risk of coronary heart disease or type 2 diabetes, but high iron intakes may increase the risk of colorectal cancer. The dietary levels of iron associated with health risks in differentHFE genotypes must be determined.
Article
Ferritin structure is designed to maintain large amounts of iron in a compact and bioavailable form in solution. All ferritins induce fast Fe(II) oxidation in a reaction catalyzed by a ferroxidase center that consumes Fe(II) and peroxides, the reagents that produce toxic free radicals in the Fenton reaction, and thus have anti-oxidant effects. Cytosolic ferritins are composed of the H- and L-chains, whose expression are regulated by iron at a post-transcriptional level and by oxidative stress at a transcriptional level. The regulation of mitochondrial ferritin expression is presently unclear. The scope of the review is to update recent progress regarding the role of ferritins in the regulation of cellular iron and in the response to oxidative stress with particular attention paid to the new roles described for cytosolic ferritins, to genetic disorders caused by mutations of the ferritin L-chain, and new findings on mitochondrial ferritin. The new data on the adult conditional knockout (KO) mice for the H-chain and on the hereditary ferritinopathies with mutations that reduce ferritin functionality strongly indicate that the major role of ferritins is to protect from the oxidative damage caused by iron deregulation. In addition, the study of mitochondrial ferritin, which is not iron-regulated, indicates that it participates in the protection against oxidative damage, particularly in cells with high oxidative activity. Ferritins have a central role in the protection against oxidative damage, but they are also involved in non-iron-dependent processes.
Article
Routinely measuring iron status is necessary because about 6% of Americans have negative iron balance, about 10% have a gene for positive balance, and about 1% have iron overload. Deviations from normal iron status are as follows. (a) Stage I and II negative iron balance, ie, iron depletion: In these stages iron stores are low and there is no dysfunction. In stage I negative iron balance, reduced iron absorption produces moderately depleted iron stores. Stage II negative iron balance is characterized by severely depleted iron stores. More than half of all cases of negative iron balance fall into these two stages. When persons in these stages are treated with iron, they never develop dysfunction or disease. (b) Stage III and IV negative iron balance, ie, iron deficiency: Iron deficiency is characterized by inadequate body iron for normal function, producing dysfunction and disease. In stage III negative iron balance, dysfunction is not accompanied by anemia; anemia develops in stage IV negative iron balance. (c) Stage I and II positive iron balance: Stage I positive balance usually lasts for several years with no dysfunction. Supplements of iron and/or vitamin C promote progression to dysfunction or disease. Iron removal prevents progression to disease. Iron overload disease develops in stage II positive iron balance after years of iron overload has caused progressive damage to tissues and organs. Again, iron removal stops disease progression. There are a variety of indicators of iron status. Serum ferritin is in equilibrium with body iron stores.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
ACD is probably the most common anemia among hospitalized medical patients. It is variably defined by its clinical and, particularly, its laboratory manifestations. The most consistent features are low serum iron and normal or increased serum ferritin levels, reflecting normal or increased iron stores and distinguishing ACD from iron deficiency anemia. ACD often coexists with iron deficiency and the anemia of renal insufficiency. Most patients have an underlying infectious, inflammatory, or neoplastic disease, but as many as one quarter of patients do not. Several mechanisms have been proposed, the most significant of which are a block in reutilization of hemoglobin iron for red cell production and relative deficiency of erythropoietin, but the pathogenesis and mediators involved remain uncertain. The anemia itself seldom requires treatment and is ameliorated by successful treatment of the underlying disease.
Article
Clinical manifestations attributable to the damaging effects of iron occur when the total body iron is 5-10 times higher than normal. In adults this degree of iron overload occurs in hereditary hemochromatosis, a human leukocyte antigen (HLA)-linked autosomal recessive disorder, as well as in secondary iron-overload conditions.
Article
The objective of the study was to evaluate the diagnostic efficiency of laboratory tests, including serum transferrin receptor (TfR) measurements, in the diagnosis of iron depletion. The patient population consisted of 129 consecutive anemic patients at the University Hospital of Turku who were given a bone marrow examination. Of these patients, 48 had iron deficiency anemia (IDA), 64 anemia of chronic disease (ACD), and 17 patients had depleted iron stores and an infectious or an inflammatory condition (COMBI). Depletion of iron stores was defined as a complete absence of stainable iron in the bone marrow examination. Serum TfR concentrations were elevated in the vast majority of the IDA and COMBI patients, while in the ACD patients, the levels were within the reference limits reported earlier for healthy subjects. TfR measurement thus provided a reliable diagnosis of iron deficiency anemia (AUC(ROC) 0.98). Serum ferritin measurement also distinguished between IDA patients and ACD patients. However, the optimal decision limit for evaluation of ferritin measurements was considerably above the conventional lower reference limits, complicating the interpretation of this parameter. Calculation of the ratio TfR/log ferritin (TfR-F Index) is a way of combining TfR and ferritin results. This ratio provided an outstanding parameter for the identification of patients with depleted iron stores (AUC(ROC) 1.00). In anemic patients, TfR measurement is a valuable noninvasive tool for the diagnosis of iron depletion, and offers an attractive alternative to more conventional laboratory tests in the detection of depleted iron stores.
Article
To determine the prevalence of iron deficiency and iron deficiency anemia in the US population. Nationally representative cross-sectional health examination survey that included venous blood measurements of iron status. Iron deficiency, defined as having an abnormal value for at least 2 of 3 laboratory tests of iron status (erythrocyte protoporphyrin, transferrin saturation, or serum ferritin); and iron deficiency anemia, defined as iron deficiency plus low hemoglobin. A total of 24,894 persons aged 1 year and older examined in the third National Health and Nutrition Examination Survey (1988-1994). Nine percent of toddlers aged 1 to 2 years and 9% to 11% of adolescent girls and women of childbearing age were iron deficient; of these, iron deficiency anemia was found in 3% and 2% to 5%, respectively. These prevalences correspond to approximately 700,000 toddlers and 7.8 million women with iron deficiency; of these, approximately 240,000 toddlers and 3.3 million women have iron deficiency anemia. Iron deficiency occurred in no more than 7% of older children or those older than 50 years, and in no more than 1% of teenage boys and young men. Among women of childbearing age, iron deficiency was more likely in those who are minority, low income, and multiparous. Iron deficiency and iron deficiency anemia are still relatively common in toddlers, adolescent girls, and women of childbearing age.
Article
Rapid advances were made in understanding the molecular and cellular bases of iron metabolism and its disorders. Molecular mechanisms for the cellular uptake, storage, and utilization of iron were clarified in investigations of the structure and functions of transferrin, transferrin receptor, ferritin, erythroid delta-aminolevulinic acid synthase, and the RNA-binding protein termed the iron responsive-element binding protein. Evidence was obtained that a nuclear DNA-binding protein, NF-E2, may be involved in the regulation of both hemoglobin synthesis in erythroid cells and of iron absorption in the intestine. Clinically, progress was made in improving the diagnosis and management of both iron deficiency and iron overload, with studies of the usefulness of serum transferrin receptor measurements, of a new therapeutic preparation of iron using a "gastric delivery system," and of the development of new orally active iron-chelating agents.
Article
Diverse clinical disorders distinct from hereditary hemochromatosis are associated with accumulation of excess body iron in heterogeneous patterns and through various mechanisms. A deranged iron turnover somehow relates to the altered physiological barrier for iron absorption in several defined chronic anemias with ineffective erythropoiesis. Unexcretable excess iron acquired from transfusions provides a therapeutic challenge. Genetic defects of proteins essential for transport of iron into and out of cells (transferrin and ceruloplasmin) deprive the erythron of the metal and cause its accumulation in other vital organs. The hemochromatosis alleles predictably contribute to an iron burden from other causes, commonly facilitate the expression of porphyria cutanea tarda, and their clinical expression may be accelerated by hereditary hemolytic anemias. Even minimal iron excess in liver disease may contribute to the hepatocellular injury from factors such as alcohol and viruses. Uniquely localized siderosis occurs in the lung and kidney where iron cannot turn over and causes variable tissue damage. The most devastating iron overload disorder, neonatal hemochromatosis, is understood least of all.
Article
This volume is the newest release in the authoritative series issued by the National Academy of Sciences on dietary reference intakes (DRIs). This series provides recommended intakes, such as Recommended Dietary Allowances (RDAs), for use in planning nutritionally adequate diets for individuals based on age and gender. In addition, a new reference intake, the Tolerable Upper Intake Level (UL), has also been established to assist an individual in knowing how much is "too much" of a nutrient. Based on the Institute of Medicine's review of the scientific literature regarding dietary micronutrients, recommendations have been formulated regarding vitamins A and K, iron, iodine, chromium, copper, manganese, molybdenum, zinc, and other potentially beneficial trace elements such as boron to determine the roles, if any, they play in health. The book also: • Reviews selected components of food that may influence the bioavailability of these compounds. • Develops estimates of dietary intake of these compounds that are compatible with good nutrition throughout the life span and that may decrease risk of chronic disease where data indicate they play a role. • Determines Tolerable Upper Intake levels for each nutrient reviewed where adequate scientific data are available in specific population subgroups. • Identifies research needed to improve knowledge of the role of these micronutrients in human health. This book will be important to professionals in nutrition research and education.
Article
The hypothesis that consumption of red and processed meat increases colorectal cancer risk is reassessed in a meta-analysis of articles published during 1973-99. The mean relative risk (RR) for the highest quantile of intake vs. the lowest was calculated and the RR per gram of intake was computed through log-linear models. Attributable fractions and preventable fractions for hypothetical reductions in red meat consumption in different geographical areas were derived using the RR log-linear estimates and prevalence of red meat consumption from FAO data and national dietary surveys. High intake of red meat, and particularly of processed meat, was associated with a moderate but significant increase in colorectal cancer risk. Average RRs and 95% confidence intervals (CI) for the highest quantile of consumption of red meat were 1.35 (CI: 1.21-1.51) and of processed meat, 1.31 (CI: 1.13-1.51). The RRs estimated by log-linear dose-response analysis were 1.24 (CI: 1.08-1.41) for an increase of 120 g/day of red meat and 1.36 (CI: 1.15-1.61) for 30 g/day of processed meat. Total meat consumption was not significantly associated with colorectal cancer risk. The risk fraction attributable to current levels of red meat intake was in the range of 10-25% in regions where red meat intake is high. If average red meat intake is reduced to 70 g/week in these regions, colorectal cancer risk would hypothetically decrease by 7-24%.
Article
Population-based hemochromatosis screening has been suggested with the rationale that identification and treatment of subclinical disease would decrease morbidity and mortality due to hemochromatosis. To examine the prevalence of elevated serum transferrin saturation levels and the burden of illness of hemochromatosis in terms of ambulatory visits, hospitalizations, and death in the United States. Four nationally representative data sets were used for the analysis of the prevalence of hemochromatosis as well as ambulatory care, hospitalizations, and deaths related to hemochromatosis. Participants included men and nonpregnant women aged 18 years and older in the Third National Health and Nutrition Examination Survey (1988-1994) and the 1996, 1997, and 1998 National Ambulatory Care Survey, National Hospital Discharge Survey, and Underlying Cause-of-Death Mortality Files. The data sets were based on single measurements of serum transferrin saturation levels, serum ferritin levels, and healthcare provider-recorded diagnoses according to the International Classification of Diseases, Ninth Revision, Clinical Modification, code for hemochromatosis. The prevalence of elevated serum transferrin saturation levels ranged from 1% to 6%. When an elevated serum transferrin saturation level of 55% is combined with an elevated serum ferritin level, the prevalence decreases from 1.9% to 0.65%. The proportion of diagnosed hemochromatosis utilization out of total ambulatory visits, hospitalizations, and deaths is stable across the measures and the 3 years of data ranging from 0.01% to 0.03%. When white men were examined separately, the relationships remained the same as those among the general population of adults. Although a substantial proportion of adults whose condition is not currently diagnosed would be identified in a population-based screening program for subclinical hemochromatosis, diagnosed morbidity or mortality owing to hemochromatosis is considerably lower than would be expected. Recommendations for screening programs may need to be revisited.
Article
The term telogen effluvium, first coined by Kligman in 1961, refers to the loss of club (telogen) hair in disease states of the follicle. Kligman's hypothesis was that whatever the cause of hair loss, the follicle tends to behave in a similar way, namely the premature termination of anagen. "The follicle is precipitated into catagen and transforms into a resting stage that mimics telogen." Ipso facto the observation of telogen hair loss does not infer a cause. To establish the cause of the hair loss, one requires a history to identify known triggers, biochemical investigations to exclude endocrine, nutritional or autoimmune aetiologies and in many cases histology to identify the earliest stages of androgenetic alopecia. The duration of the hair loss at presentation helps predict those patients in whom further investigation will have the greatest yield. "It is unfortunate that baldness has been approached with an eye toward "regrowing" or "restoring hair", and thus with a tendency toward commercialism. Locked within the metamorphosing hair follicles in the balding scalp are all the secrets of growth and differentation. Searching for these secrets should transcend the eagerness to "regrow" hair on a bald scalp, an achievement which is of no great consequence. When we know these answers, we shall have the key, not to hair growth alone, but to all growth, which is, after all, the basis of all biological phenomena." William Montagna, 1959.
Article
Iron deficiency is prevalent in populations seen in primary practices. It is easily evaluated and treated, but often undiagnosed. Iron deficiency can lead not only to anemia but to decreased work capacity, abnormal neurotransmitter function, and altered immunologic and inflammatory defenses. Risk for iron deficiency is a function of iron loss, iron intake, iron absorption, and physiologic demands. Women of child-bearing age are at especially high risk for iron deficiency due to ongoing menstrual blood losses. This article presents and describes a simple algorithm incorporating dietary considerations for evaluation and treatment of iron deficiency in primary care settings.
Article
There are numerous ways of classifying the causes of anemia, and no one way is necessarily superior to another. It is equally important to appreciate the differences in the approaches to diagnosis between children and adults, men and women, and persons of different ethnic backgrounds. Regardless of the specific algorithm followed in evaluating anemia, it is essential that easily remediable causes such as nutritional deficiencies, hemolysis, and anemia of renal insufficiency are identified early and treated appropriately. In general, the differential diagnosis of anemia can be substantially narrowed by subcategorization into "microcytic," "normocytic," and "macrocytic" subtypes on the basis of mean corpuscular volume. However, such classification is a starting point and not infallible. Each category then can be deciphered using a stepwise approach that utilizes readily accessible laboratory tests.
Article
Alopecia in women is a common problem, and conflicting observational data have failed to determine whether an association exists between alopecia and iron deficiency in women. We therefore utilized an analytical cross-sectional methodology to evaluate whether common types of alopecia in women are associated with decreased tissue iron stores, as measured by serum ferritin. We studied patients with telogen effluvium (n = 30), androgenetic alopecia (n = 52), alopecia areata (n = 17), and alopecia areata totalis/universalis (n = 7). The normal group consisted of 11 subjects without hair loss from the same referral base and source population as those patients with alopecia. We analyzed the data utilizing the unpaired Student's t test assuming unequal variances with an alpha adjustment for multiple comparisons to assess whether the mean ages, ferritin levels, and hemoglobin levels of women without hair loss differed from the means in each alopecia group. The mean age of patients and normals did not differ significantly. We found that the mean ferritin level (ng per ml [95% confidence intervals]) in patients with androgenetic alopecia (37.3 128.4, 46.1]) and alopecia areata (24.9 [17.2, 32.6]) were statistically significantly lower than in normals without hair loss (59.5 [40.8, 78.1]). The mean ferritin levels in patients with telogen effluvium (50.1 [33.9, 66.33]) and alopecia areata totalis/universalis (52.3 [23.1, 81.5]) were not significantly lower than in normals. Our findings have implications regarding therapeutics, clinical trial design, and understanding the triggers for alopecia.
Article
Iron deficiency is a major worldwide health problem. There is recent evidence that the anemia is only the last manifestation of the syndrome and that symptoms occur before the anemia is manifest. Advances in outlining the physiology of iron deficiency have been made, gaps remain in the current understanding. While oral iron supplement remains the mainstay, some indications for the intravenous administration have developed. This review will highlight the epidemiology, physiology, clinical presentation, and treatment options.
Causes and diagnosis of anemia due to iron deficiency
  • S L Schrier
Schrier SL. Causes and diagnosis of anemia due to iron deficiency. Available from: www.UpToDate.com. Accessed April 18, 2005; last updated November 6, 2003.
Approach to the patient with anemia
  • S L Schrier
Schrier SL. Approach to the patient with anemia. Available from: www.UpToDate.com. Accessed April 18, 2005; last updated November 22, 2004.
Modified food guide pyramid for lactovegetarians and vegans Schrier SL. Regulation of iron balance. Available from: www
  • Ca Venti
  • Johnston
Venti CA, Johnston CS. Modified food guide pyramid for lactovegetarians and vegans. J Nutr 2002;132:1050-4. 38. Schrier SL. Regulation of iron balance. Available from: www.UpToDate.com. Accessed April 18, 2005; last updated January 21, 2005.
AHFS drug information. Iron preparations, oral Available from: http://online.statref.com/document.aspx?fxid=1 &docid=365
  • Gk Mcevoy
McEvoy GK. AHFS drug information. Iron preparations, oral. Available from: http://online.statref.com/document.aspx?fxid=1 &docid=365. Accessed June 4, 2005; last updated May 27, 2005.
Treatment of and screening for hered-itary hemochromatosis Available from: www.UpToDate.com
  • Schrier
  • Sl
  • Bacon
Schrier SL, Bacon BR. Treatment of and screening for hered-itary hemochromatosis. Available from: www.UpToDate.com. Accessed April 23, 2004; last updated January 9, 2004.
Regulation of iron balance Available from: www.UpToDate.com
  • Sl Schrier
Schrier SL. Regulation of iron balance. Available from: www.UpToDate.com. Accessed April 18, 2005; last updated January 21, 2005.
Niferex Elixer: Schwarz Pharma, Milwaukee, Wis. Modified from ''Iron preparations, oral AHFS (American Hospital Formulary Service) drug information
  • Fe-Tinic
  • Ethex
  • St
  • Louis
  • Mo
  • Hytinic
Fe-Tinic 150, Ethex, St. Louis, Mo; Hytinic, Hyrex Pharmaceuticals, Memphis, Tenn; Niferex Elixer: Schwarz Pharma, Milwaukee, Wis. Modified from ''Iron preparations, oral.'' In: McEvoy GK, editor. AHFS (American Hospital Formulary Service) drug information 2005. Bethesda (MD): American Society of Health-System Pharmacists, Inc; 2005. p. 1403. With permission of the American REFERENCES
Iron deficiency and other hypoproliferative anemias Harrison's principles of internal medicine
  • Jw Adamson
  • Kasper Dl
  • E Braunwald
  • As Fauci
  • Hauser
  • Sl
  • Longo
  • Dl
  • Jameson
  • Jl
Adamson JW. Iron deficiency and other hypoproliferative anemias. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 16th ed. New York: McGraw-Hill; 2005. pp. 586-92.
Disorders of iron metabolism: iron deficiency and overload Hematology: basic prin-ciples and practice
  • Gm Brittenham
Brittenham GM. Disorders of iron metabolism: iron deficiency and overload. In: Hoffman R, editor. Hematology: basic prin-ciples and practice. 3rd ed. New York: Churchill-Livingstone; 2000. pp. 397-428.
Diffuse alopecia: telogen hair loss Disorders of hair growth: diagnosis and treatment
  • Fiedler
  • Vc
  • Gray
  • Ac
Fiedler VC, Gray AC. Diffuse alopecia: telogen hair loss. In: Olsen EA, editor. Disorders of hair growth: diagnosis and treatment. 2nd ed. New York: McGraw-Hill; 2003. pp. 303-20.