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    Complementary and Alternative Medical Lab Testing Part 16: Hematology
    Complementary and Alternative Medical Lab Testing Part 16: Hematology
    Complementary and Alternative Medical Lab Testing Part 16: Hematology
    Ebook115 pages1 hour

    Complementary and Alternative Medical Lab Testing Part 16: Hematology

    By Ronald Steriti

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    About this ebook

    Complementary and Alternative Medical Lab Testing (CAM Labs) contains summaries of the published research on lab tests, primarily from PubMed trials on humans. Each chapter (disease) begins with a brief summary of conventional lab tests, followed by additional lab tests, including diabetes, insulin resistance, metabolic syndrome, inflammation, etc. There are sections on endocrine hormones (thyroid, adrenal, sex steroids) and environmental medicine (toxic heavy metals). The nutritional assessments section includes minerals, vitamins and amino acids.

    CAM Labs 16 – Hematology

    1. Anemia
    2. Hemochromatosis
    3. Iron Deficiency
    4. Leukopenia
    5. Platelets

    LanguageEnglish
    PublisherRonald Steriti
    Release dateJun 4, 2016
    ISBN9781311774569
    Complementary and Alternative Medical Lab Testing Part 16: Hematology
    Author

    Ronald Steriti

    Dr. Ronald Steriti is a graduate of Southwest College of Naturopathic Medicine and currently is researcher for Jonathan V. Wright at the Tahoma Clinic.

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      Book preview

      Complementary and Alternative Medical Lab Testing Part 16 - Ronald Steriti

      Complementary and Alternative

      Medical Lab Testing

      Part 16: Hematology

      By Ronald Steriti, ND, PhD

      ©

      Complementary and Alternative Medical Lab Testing Clinician’s Guide Part 16: Hematology

      By Ronald Steriti, ND, PhD

      Copyright © 2016

      All rights reserved. No part of this book may be reproduced in any form or by any means, including photocopying, including in a web site, or stored in a retrieval system, or transmitted in any form by any means, without expressed, written permission of the copyright owner.

      The contents of this document are the sole property of the author.

      Disclaimer

      This book has not been evaluated by the FDA and is not intended to diagnose, treat, cure or prevent any disease.

      The information contained in this book is for educational purposes only, and should not be construed as medical advice or instruction. No action should be taken based solely on the contents of this book. Readers should consult appropriate health officials.

      While extensive efforts have been made to ensure the accuracy of the information contained, the possibility of errors, omissions, and misinterpretations cannot be ruled out. The reader is advised to consult the original references for verification and clarification.

      Foreward

      This book is a summary the published research on lab tests, primarily from PubMed. The studies are limited to those with trials on humans. As such, some labs may be excluded due to the lack of published research. That is simply a reflection of the current state of research - much more work is needed!

      Although this book may be useful for differential diagnosis, lab tests are can also be used to identify inderlying causes and associated conditions.

      The sections on conventional lab tests are purposefully brief. These tests are typically used to confirm a diagnosis. There are other more comprehensive sources of information on conventional medical lab testing.

      Table of Contents

      1. Anemia

      2. Hemochromatosis

      3. Iron Deficiency

      4. Leukopenia

      5. Platelets

      Chapter 1. Anemia

      Conventional Lab Tests

      Hemoglobin (Hb) less than 12.5 g/dL (adults)

      MCV, Iron (ferritin), TIBC

      Additional Lab Tests

      Albumin and GFR

      Hemoglobin was used to identify those with anemia in a group of centenarians and near centenarians (98+, n = 185) and octogenarians (n = 69), who were recruited as part of the population-based multidisciplinary Georgia Centenarian Study. The prevalence of anemia was 26.2% in octogenarians and 52.1% in centenarians. Low serum albumin (<3.6 g/dL) and decreased estimated glomerular filtration rate (<45 mL/min/m(2)) were predictors of anemia in centenarians. (Haslam et al., 2012)

      Digestive Assessments

      Celiac Disease

      Adolescent and adult patients presenting with nutritional anemia were prospectively screened for CD using IgA anti-tissue transglutaminase antibody (anti-tTG Ab) followed, if positive, by upper gastrointestinal endoscopy and duodenal biopsy. Ninety-six patients [mean +/- SD age 32.1 +/- 13.1 years and median duration of anemia 11 months (range 1 to 144 months)] were screened. Of these patients, 80 had iron deficiency anemia, 11 had megaloblastic anemia, and 5 had dimorphic anemia. Seventy-three patients were on hematinics and 36.4 % had received blood transfusions. Nineteen had a history of chronic diarrhea and the mean +/- SD duration of diarrhea in them was 9.7 +/- 35.8 months. IgA anti-tTG Ab was positive in 13 patients, of whom 12 agreed to undergo duodenal biopsy. Ten patients had villous atrophy (Marsh grade 3a in three, 3b in one, and 3c in six) and two did not. Thus, 10 patients with nutritional anemia (iron deficiency 9, vitamin B12 deficiency 1) were diagnosed to have CD. On multivariate logistic regression, age, duration of symptoms, and presence of diarrhea were found to be the predictors of CD. All the patients with CD were put on gluten-free diet and with iron and vitamin supplementations and showed a significant improvement in hemoglobin concentration. CD screening should be included in the work up of otherwise unexplained nutritional anemia. (Kavimandan et al., 2014)

      Anemia in celiac disease (CD) has been attributed to nutritional deficiencies; however, the clinical manifestations of CD have changed with nongastrointestinal presentations predominating. We collected hematologic parameters from a cohort of patients seen at a tertiary care center for CD to assess the characteristics of anemia in this population. Hematological parameters measured 1995 was analyzed. Ferritin levels were compared with population controls (NHANES III). Iron deficiency was common, occurring in 33% of men and 19% of women (P < 0.001). Folate deficiency was seen in approximately 12% of the total sample and B12 deficiency in approximately 5%. Anemia was present in approximately 20% of the cohort. Among the anemic patients, ferritin was less than the 10th percentile in 45%, between the 10th and 50th percentile in 39% and greater than the 50th percentile in 13%. Ferritin > 50th percentile was more common in anemic men (24%) than in anemic women (9%; P > 0.20). Macrocytic anemia with concurrent B12 or folate deficiency was rare (3%). Elevated ESR was observed in patients with ferritin < 10th percentile and >50th. A gluten-free diet resulted in increased serum ferritin in iron-deficient patients, and decreased ferritin levels in those with high ferritin (r(2) = 0.46, P < 0.001). Although anemia is still a common presentation of celiac disease, nutritional deficiencies alone do not explain this phenomenon in all cases; inflammation appears to contribute as evidenced by the presence of anemia of chronic disease in some individuals. (Harper et al., 2007)

      Malabsorption

      Anemia is a frequent finding in most diseases which cause malabsorption. The most frequent etiology is the combination of iron and vitamin B12 deficiency. Celiac disease is frequently diagnosed in patients referred for evaluation of iron deficiency anemia (IDA), being reported in 1.8%-14.6% of patients. (Fernandez-Banares et al., 2009)

      Comprehensive Sex Steroid Panel

      Estradiol in Elderly Men

      The MrOS (Osteoporotic Fractures in Men) is a population-based study (n=918, median age 75.3 years, range 70-81 years) that evaluated total estradiol in relation to Hb and adjusted for potential confounders (i.e. age, body mass index (BMI), erythropoietin (EPO), total testosterone, cystatin C, iron- and B-vitamin status). Estradiol correlated negatively with age (r=-0.14, p<0.001). Hb correlated (age adjusted) positively with estradiol (r=0.21, p<0.001) and testosterone (r=0.10, p<0.01). Independent predictors for Hb in multivariate analyses were estradiol, EPO, BMI, transferrin saturation, cystatin C and free T4 but not testosterone. After exclusion of subjects with Hb <130g/L and/or testosterone <8 nmol/L (n=99), the correlation between Hb and testosterone was no longer significant, whereas the associations between Hb and estradiol remained. After adjusting for age, BMI and EPO, men with lower estradiol levels were more likely to have Hb in the lowest quartile of values [OR per SD decrease in estradiol = 1.61 (95% CI 1.34-1.93)]. Anemic subjects (Hb <130 g/L) had lower mean estradiol than non-anemic (67.4 vs 79.4 pmol/L, p<0.001). Estradiol correlated, positively and independently, with Hb. Decreased estradiol might partly explain the age-related Hb decline observed in healthy elderly men. (Lewerin et al., 2014)

      Testosterone in Older Men and Women

      Testosterone and hemoglobin levels were measured in a representative sample of 905 persons 65 years or older without cancer, renal insufficiency, or anti-androgenic treatments. Hemoglobin levels were reassessed after 3 years. At baseline, 31 men and 57 women had anemia. Adjusting for confounders, we found that total and bioavailable testosterone levels were associated with hemoglobin levels in women (P = .001 and P = .02, respectively) and in men (P<.001 and P = .03, respectively). Men and women in the lowest quartile of total and bioavailable testosterone were more likely than

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