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Anemia, Iron Deficiency

Red Blood Cell Comparison. Courtesy medindia.com
Red Blood Cell Comparison. Courtesy medindia.com

What Is Iron Deficiency Anemia?

[dropcap]I[/dropcap]ron deficiency anemia is a blood cell disorder that is characterized by formation of small, pale red blood cells, causing tissue hypoxia. Hypoxia is the inability to meet the demands of the body for oxygen.

Q: Why do small, pale red blood cells cause tissue hypoxia?

A: Small, pale red blood cells (erythrocytes) cause tissue hypoxia because they are not able, as do normal erythrocytes, to pick up adequate oxygen from the lungs and carry it to cells that use oxygen.

Red blood cell production and function are dependent on a sufficient level of iron in the body and also the ability to use available iron to make hemoglobin in red blood cells.

Hemoglobin is a protein that binds oxygen in red blood cells to be carried by the bloodstream to cells throughout the body. In iron deficiency anemia,  hemoglobin in females is below 12.5g/dl (normal range is 12.5 to 16g/dl) and in males it is below 13.5g/dl (normal range is 13.5 to 17.5g/dl).

Iron must be obtained from the diet, since the body cannot make it, but there are various factors that can interfere with absorption and use in the body, causing anemia. Iron absorption from the gut first requires ionization, or gaining a positive electrical charge, in the strongly acidic environment of stomach juice. Ionized iron, only, can be absorbed in the duodenum, which receives the acidic contents of the stomach before it is neutralized further along.

Dietary iron can be heme or non-heme depending on the food source. Heme iron obtained only from animal food sources is absorbed into the bloodstream by active transport across the brush border (microvilli) which cover the multitudinous villi of the small intestinal lining.

Non-heme iron obtained from plants must bind with apoprotein after entering the enterocyte (surface cell of small intestinal lining) to be ferried to the underlying basolateral membrane and exited by active transport into the bloodstream.

Frequently, chronic anemia due to iron deficiency is accompanied by increased platelets, and this thrombocytosis resolves with iron repletion (normal iron level). Conversely, in severe iron deficiency anemia, patients may have thrombocytopenia (low platelets), which also resolves with iron therapy.1

What Is Iron Deficiency Anemia In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Koury M and Rhodes M. How to approach chronic anemia. Hematology Am Soc Hematol Educ Program. 2012;2012:183-90. doi: 10.1182/asheducation-2012.1.183. [↩]

Muscle Weakness 

Muscle fiber anatomy. Courtesy NIH.
Muscle Fiber Anatomy. Courtesy NIH.

What Is Muscle Weakness?

[dropcap]M[/dropcap]uscle weakness is the impaired status of muscle function characterized by decreased or low muscle strength and inability to perform normal work such as lifting a pot off the stove.

Q: How do muscles work?

A: Muscles do their work by contracting or shortening. For example, to move the foot up and down at the ankle, muscles attached to the foot by tendons must contract to shorten or relax to return to their resting length. Calf muscles contract to point the foot down (flexion) while the shin muscles relax (extension).  For the foot to point up, calf muscles relax while the opposing shin muscles contract.

Each muscle is made up of individual muscle fibers. A muscle fiber is a long cylindrical cell that contains many nuclei, mitochondria, and sarcomeres. Each muscle fiber is surrounded by a thin layer of connective tissue called the endomysium.

Approximately 20–80 of these muscle fibers are grouped together in a parallel arrangement called a muscle fascicle or fiber bundle that is encapsulated by a perimysium. A distinct muscle is formed by enveloping a large number of muscle fascicles in a thick collagenous external sheath extending from the tendons called the epimysium.1

Muscles fall into three types:

  • Voluntary muscles.  These muscles, also called skeletal, we can control by will. Voluntary muscles function by contracting their fibers to draw one part of the body toward another in flexion while opposing muscles that extend or pull a body part away from another. They move our bones to perform activities such as walking to get somewhere, chewing to eat food, lifting to do work, and moving the eyeball to look at something.
  • Involuntary muscles. These muscles work independently of our conscious control. They are needed for internal organs, sphincters, and other parts to do their work, such as peristalsis in the gut that must function at all times to digest and move food, the squirting of bile juice into the duodenum by the Sphincter of Odi in the presence of fat eaten, and action of the pupil to see.
  • Cardiac muscles. These muscles are specialized to keep the heart functioning at all times.

  Muscle weakness can involve all types of muscles.

What Is Muscle Weakness In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. http://www.ncbi.nlm.nih.gov/books/NBK57140/ [↩]

Cataracts

Slit lamp view of cataract in human eye. Courttesy Wikimedia
Slit lamp view of cataract in human eye. Courtesy Wikimedia

What Are Cataracts?

[dropcap]C[/dropcap]ataract is a clouding of the normally clear lens in an affected eye characterized by blurred vision and progressive blindness due to loss of the len’s ability to focus light rays on the retina. Cataracts can occur in either or both eyes.

Q: How does a cataract form?

A: The lens is a transparent, colorless, oval-like structure of the eye made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light coming through the pupil to pass through it to reach the retina where it is recorded. Once an image reaches the retina, it is changed into nerve signals that are sent to the brain.1

In each eye, the lens is enclosed in a capsule that is held in place directly behind the pupil by the ciliary body and the suspensory ligaments. The lens consists primarily of lens fibers that at the periphery are soft, forming the cortis lentis, and in the center are of a harder consistency, forming the nucleus lentis. Beneath the capsule on the front surface is a layer of cells, the lens epithelium. The shape of the lens is changed by the ciliary muscle to focus light rays onto the retina.2

A cataract begins to form when some of the protein clumps together and starts to cloud a small area of the lens. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.3

A cataract is diagnosed by an ophthalmologist, who is a medical doctor specializing in the treatment of eye conditions. The eye examination involves viewing the anterior (front) of the eye by means of a slit lamp microscope. This instrument allows detailed observation of the lens and its supporting structures.

What Are Cataracts In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Tabers Cyclopedic Medical Dictionary. 19th ed. FA Davis Company, Philadelphia, PA. [↩]
  2. Tabers Cyclopedic Medical Dictionary.C 19th ed. FA Davis Company, Philadelphia, PA. [↩]
  3. http://www.nei.nih.gov/health/cataract/cataract_facts [↩]