Anemia

Anemia occurs when the amount of hemoglobin (found in the red blood cells) drops below normal. Hemoglobin is necessary for the transport and delivery of oxygen throughout the body. There are many different types of anemia, but we will limit this page to the most common ones.

Iron and Vitamin Deficiencies
Iron deficiency anemia is the most common of the anemias and is usually due to bleeding. In women, iron deficiency may be due to heavy menstrual periods, but in older women and in men, the bleeding is usually from disease of the intestines. In children and in pregnant women, the body needs more iron, and iron deficiency may be due simply to not eating enough iron in the diet. Iron deficiency may also result from some extreme diets. Treatment of iron deficiency usually involves iron supplements. In older women and in men, there is usually also some further testing to determine the reasons for the abnormal blood loss.

Pregnant and nursing women frequently develop this deficiency since the baby requires large amounts of iron for growth. Lack of iron can lead to low birth weight babies and premature delivery. Pre-pregnant and pregnant women are routinely given iron supplements to prevent these complications. Newborns who are nursing from deficient mothers tend to have iron deficiency anemia as well.

Blood tests may show a normal or low hemoglobin, decreased iron, low ferritin, and abnormal red blood cell indices. The total iron-binding capacity (TIBC) or transferrin will be increased. The ferritin test is considered to be the most specific for identifying iron deficiency anemia, unless infection or inflammation are present.

Vitamin B12 deficiency is less common than iron deficiency and is usually not due to dietary deficiency of vitamin B12. The most common cause is a disease called pernicious anemia, in which the body stops making a substance (called “intrinsic factor”) that is needed to absorb vitamin B12 from the diet. Vitamin B12 deficiency can also cause nerve problems, often causing numbness and tingling that start first in the hands and feet. Hemoglobin is low, but red blood cells are abnormally large.

Folic acid deficiency can cause the same pattern of changes in hemoglobin and red cell indices as does vitamin B12 deficiency. Folic acid is found in many foods, especially in green, leafy vegetables. Folic acid is also added to most grain products in the United States so that deficiency in folic acid is rarely seen in the U.S. today. During pregnancy, however, there is an increased need for folic acid so deficiency can develop during this time. This is especially dangerous because deficiency in folic acid can cause problems in the development of the brain and spinal cord of the baby. Pregnant women usually need folic acid supplements.

Aplastic Anemias
Aplastic anemia is a rare disease, caused by a decrease in the number of blood cells produced due to bone marrow failure. Symptoms of aplastic anemia include prolonged bleeding and the frequent appearance of bruises due to decreased platelets, pale skin color and fatigue from decreased hemoglobin, and increased number and severity of infections due to a low white blood cell count. The differential white blood count shows a decrease in all types of cells (pancytopenia). A bone marrow aspiration will show a decrease in the number of mature cells. Treatment depends on the cause. Blood transfusions and a bone marrow transplant may be needed in severe cases.

Vitamin D

Formal name: 25-hydroxy-vitamin D (Calcidiol); 1,25 dihydroxy-vitamin D (Calcitriol)
Related blood tests: Calcium, Phosphorus, Parathyroid Hormone (PTH), Magnesium

How is it used?
Vitamin D blood tests are used to determine if bone weakness, bone malformation, or abnormal metabolism of calcium (reflected by abnormal calcium, phosphorus or PTH blood tests) is occurring as a result of a deficiency or excess of vitamin D.

Since vitamin D is fat-soluble and is absorbed from the intestine like a fat, vitamin D blood tests are sometimes used to monitor individuals with diseases that interfere with fat absorption, such as cystic fibrosis and Crohn’s disease, to assure that they have adequate amounts of vitamin D. Vitamin D blood tests also are used to determine effectiveness of treatment when vitamin D, calcium, phosphorus, and/or magnesium supplementation is prescribed.

When is it ordered?
Either calcidiol or calcitriol tests may be ordered when a patient has an abnormal blood calcium, phosphorus, and/or magnesium level or evidence of bone disorders.

If calcium is low or the patient has symptoms of vitamin D deficiency, such as bone malformation in children (rickets) and bone weakness, softness, or fracture in adults (osteomalacia), the calcidiol test usually is ordered to identify a possible deficiency in vitamin D.

If calcium is high or the patient has a disease that might produce excess amounts of calcitriol, such as sarcoidosis or some forms of lymphoma, the calcitriol test usually is ordered.

Vitamin D blood tests also may be used to help diagnose or monitor problems with parathyroid gland functioning since parathyroid hormone is essential for vitamin D activation. When vitamin D, calcium, phosphorus, or magnesium supplementation is necessary, vitamin D levels are sometimes measured to monitor treatment effectiveness.

What does the test result mean?
NOTE: A standard reference range is not available for this blood test. Because reference values are dependent on many factors, including patient age, gender, sample population, and test method, numeric test results have different meanings in different testing labs. Your lab report should include the specific reference range for your test. Lab Tests Online strongly recommends that you discuss your blood test results with your doctor. For more information on reference ranges, please read Reference Ranges and What They Mean.

Low blood levels of calcidiol may mean that you are not getting enough exposure to sunlight or enough dietary vitamin D to meet your body?s demand; that there is a problem with its absorption from the intestines; or that enough is not being converted to calcidiol in the liver (which means that it is not making it into the bloodstream). Occasionally, drugs used to treat seizures, particularly phenytoin (Dilantin), can interfere with the liver?s production of calcidiol.

High levels of calcidiol usually reflect excess supplementation from vitamin pills or other nutritional supplements.

Low levels of calcitriol are often seen in kidney disease and are one of the earliest changes to occur in persons with early kidney failure.
High levels of calcitriol may occur when there is excess parathryoid hormone or when there are diseases, such as sarcoidosis or some lymphomas, that can make calcitriol outside of the kidneys.

Is there anything else I should know?
High levels of vitamin D and calcium can lead to the calcification and damage of organs, such as the kidneys, as the body tries to lower blood calcium levels by depositing calcium phosphate compounds into the organs.

If magnesium levels are low, they can cause a low calcium level that is resistant to vitamin D and parathyroid hormone regulation. It may be necessary to supplement both magnesium and calcium to regain normal function.

Vitamins

Vitamins are an essential part of our lives, we need them to many body functions and without them we simply can’t be alive. There are many types of vitamins and we need to get proper levels of them in order to stay healthy. There are times however when we run the risk of having deficiencies of certain types of vitamins.

The vitamin deficiency symptoms will vary according to each type. These deficiencies most of the time are present at crucial moments in our life. For example children and pregnant women are at risk of developing certain deficiencies because they have higher requirements.