My take-away from the Debra’s PCC in Orlando – Part 4

Good Morning everyone! Today I will continue with the talks from Dr. Jakub Tolar about PIP Stem Cells to optimize EB treatment and Dr. Anna Bruckner with Anemia. To see the slides in an enlarged version, simply click on the photo.

Personalized Induced Pluripotent Stem Cells for Optimizing EB Treatment

This talk was presented by Jakob Tolar from the University of Minnesota. Dr. Tolar WON the attention of all the moms in the room with his now famous statement that his FIRST rule is to LISTEN TO THE MOTHER! Yes, round of applause! If only we could clone his point of view.

Dr. Tolar works with Dr. Wagner with the Bone Marrow Transplants, and his latest area of study is Induced pluripotent stem cells. This is commonly abbreviated as iPS cells or iPSCs are a type of pluripotent stem cell artificially derived from a non-pluripotent cell – typically an adult somatic cell – by inducing a “forced” expression of specific genes. Clear as mud? I know, it’s really complicated stuff. One of the reasons of me doing this blog is so I have a reason to go research to understand it more, in turn hopefully help others understand as well.

Dr. Tolar started his talk with the ups and downs of BMTs, how their primary goal is quality of life, lessen the symptoms of the disorder, but how there are plenty of slings and arrows coming their way, such as GVHD, infections, long term complications… that’s where the iPS cells come into play which would improve the results dramatically. If the donor is the patient itself, there is no risk of GVHD, less rejection & immune suppression drugs can be used etcetera. This is basically a continuation of what Dr. Christiano talked about earlier in the day.

This slide I think pretty much explains what they do with these iPS cells: Click on the photo for a larger view! It’s worthed, I promise!
They start with a biopsy of the patient, then introduce “Transcription Factors” (protein required to initiate or regulate eukaryotic DNA transcription), these transcription factors in essence REPROGRAM the cell to its embryonic state. Weeks later they have embryonic-like cells in return. From these cells they can grow just about anything, including skin. Of course the dna for the skin has to be corrected, but from this they can produce bone marrow to give back to the patient. AMAZING!

If anyone has anymore info on this just leave a comment in the Facebook comment section below this post. THANK YOU!

Here is the video of this presentation, courtesy of Debra:

Medical Complications of EB worth knowing about: Anemia and Low Bone Mass

Dr Anna Bruckner did this talk, she has been one of Nicky’s EB doctors at one time (before she moved to Colorado) so I was looking forward to this because Anemia & Bone Mass are some of Nicky’s issues as well.
Immediately she stated that she did not have time to address both Anemia & Low Bone Mass so she only concentrated on Anemia. Boo. I promised myself to ‘catch her’ later and I never did.

Why do EB patients get Anemia? She stated there are no ‘real’ answers on why. The most common idea is that it’s Anemia of Inflammation, caused by bleeding from the blisters, skin & GI track.

One of the points she reiterated a few times which is really important is that anemia in EB patient is a slow process and some of the symptoms are so slow in coming it’s easy to dismiss them. “Slow Decline” is how she put it. After all, who wouldn’t be tired if they had all these wounds to deal with? Pale skin is probably a big sign, but it does not appear overnight, as none of the other symptoms do as well.

The only real solution to Anemia is transfusions/infusions and there are many kinds and many different ways of doing them. I am not sure if she mentioned this in her talk but Nicky’s hematologist, who did this exact talk at the Conference in Palo Alto, checks the blood levels first. Anemic patients many times lack a protein in their blood called ‘Ferritin‘ which absorbs iron. If this protein is lacking or low, he gives a blood transfusion first, then proceeds with the iron infusions.

In her talk Dr. Bruckner talked about treating anemia with EPO, which boosts the bone marrow to produce more red blood cells.
As per the low Bone Mass… since Dr. Bruckner did not say anything, I can explain a few things in regards of what was relayed to me by Nicky’s hematologist. He became concerned when another EB patient in his care broke a bone in his leg and how a nightmare it was to make it heal with all the wounds going on in the skin-casting was out of the question. So… Nicky has been doing x-rays to check his Bone Mass every year, and while, with supplements, we’ve been able to improve the ‘quality’ of the bone, his mass has consistently gotten lower, and the only way to strengthen the bone is to walk.  Trying to make Nicky walk more and more only succeeded in destroying his feet, and then… he could not walk anymore for 3 months. Sweet! He is still trying to walk independently around the house, but 9 times out of 10 he needs my help. This is why I was looking forward to the Doctor talking about this issue because we’re at a loss. The only saving grace right now is that Nicky hasn’t gone through puberty yet but he’s close (as his bone doctor told me) and when he does his bones will strenghten up on their own. Beside that, the only other solutions would be injections every day. Oh man… I want to avoid that with every fiber of my being.

If anyone has any info I might have missed, please leave a comment below (in the Facebook comment section).  THANK YOU!

Here is the video of this presentation, courtesy of Debra:

GO TO PART 5 –>>

Links to — > Part 1Part 2 – Part 3

Mom to 3 boys, 1 in heaven, 2 on earth. My first son Alex (whose demise is most likely EB related) was stillborn at full term. After a miscarriage, I had my second son Nicky, who has the Recessive Dystrophic form of Epidermolysis Bullosa. My youngest son, Connor, is 100% healthy, and I never, ever take it for granted. I am an author, photographer, graphic artist, webmaster, blogger and more.

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Hints From Grandma Shirley

Grandma Shirley holding Nicky

Shirley, grandma and caregiver of Jennifer, an RDEB patient, shares her hints and tips and her knowledge about EB care with us.

Constipation

Hi all, I found this article in a pamphlet put out by dEBra International in their Nutrition section. Thought it might be helpful:

Constipation in babies and young children is often the result of an inadequate fluid intake, due to a reduced intake of feeds and/or increased requirements in hot weather. An EB sufferer with extensive blistering may have fluid requirements considerably above normal.
Constipation can be aggravated by iron supplements. It may also occur for no apparent reason. The frequency with which the bowels are opened is less important that the degree of discomfort felt. Provided the motions are soft and painlessly passed, it is not essential that the bowels are opened every day.
For an EB baby, straining to pass even a moderately bulky motion may cause pain and blistering of the delicate skin around the anus. Fear of pain on passing further motions can quickly lead to withholding the motion and before long a vicious cycle is set up as he becomes more constipated and appetite is reduced.
Because regular bowel movements also depend on a regular intake of food, a poor appetite and irregular feeds can lead to harder, drier motions.

The importance of preventing constipation cannot be overstated. Try to ensure a generous fluid intake i.e. at least 150 ml per kg ( 2 – 3 ounces per lb.) per 24 hours, for young babies who are not receiving fluid from foods. If your baby refuses plain, cooled, boiled water, offer well-diluted fresh fruit juice (i.e. 1 teaspoon juice diluted with 100 ml water) or give ready-to-feed baby juice diluted with an equal volume of water.
If extra fluid makes no difference to the constipation, try adding a teaspoonful of sugar to all baby feeds for several days. Alternatively, try giving the diluted juice from a tin (can) of prunes or the water in which dried prunes have been stewed. Once you baby is taking solids, try to include fruit and vegetable puree daily. From about nine months, offer wholegrain cereals such as Weetabix (English cereal – don’t know what the American version is), and from 10 – 12 months, include baked beans and sweet corn. The fiber in these foods, combined with adequate fluid (about 100 ml per kg. (1 – 2 oz. per lb), will help to keep the motions soft and they will be more comfortably passed. Unprocessed bran should not be given. If constipation persists despite these measures, a gentle laxative may be required. It is important to give this regularly as a preventative measure rather than waiting until he is very constipated. Discuss this with your doctor also.

Eye Abrasions

Here is the information I have learned from Jennifer’s experience with eye abrasions. Please discuss it with your doctor.

Jennifer has had eye “blisters” for many years. Before she came with me they were untreated and she has ended up with scar tissue on her left eye cornea. If this isn’t treated it can cause blindness. I took her to an optomologist who just happen to be familiar with EB, as he worked at St. Jude’s hospital and said there were children there who had EB. We were very lucky to have him. He did a thorough exam of Jenn’s eyes. This is what he told us:
EBer’s have a great tendency to “dry eyes”, as they are mucous membranes. He prescribed “Isopto Homatropine”. This is a drop that you put in the affected eye, and it dialates the pupil and relaxes the eye taking away the pain, and giving it a chance to rest and heal. They should be in a dark room as the pupil is dialated and light will cause damage. About five – ten minutes later eye OINTMENT should be put into the eye to keep them very moist. We use Refresh Plus Eye Ointment. The dosage – one drop three to four times a day – and the ointment as often as needed, even if it is every hour. After the eye begins to get better, use the eye drops, not the Isopto, again we use Refresh or Celluvisc Lubricant Eye Drops (I like this better – it is a little thicker) as often as necessary. When Jenn is on the computer I keep a box of Celluvisc right next to the PC and remind her often to use them, even if the eye feels good.
While she is going through the initial beginning problem it is VERY painful, swollen, red and VERY feverish. I put a few ice cubes in a clean white face rag and she holds that on her eye. This keeps the fever down and she uses MANY ice cubes, as they melt fast from the fever. Both of us dread this problem, as it is so painful for them.
I have no problem keeping her in a dark room, as she usually stays in bed for the three days, and sleeps…. Dr. Tether said the reason this happens is that EB will cause very dry eyes. When they sleep and go through the REM eye movements, their eyes blink and that scratches the eye lid and cornea, which cause the blisters. Also, as we all know they sleep with their eyes open slightly. Also, I keep Jenn’s hair back with a twister, especially at night, cause a little piece of hair that can get in the eye will also irritate the eye and cause a blister.

Prenatal Diagnose

There is now a test that can be done to see if the baby has EB. Then if he/she does, you will have to make a decision that of course none of us even want to think of – to abort or not. You will need to contact Dr. Angela Christiano – email addy: amc65@columbia.edu to get the details. She is the Dr. who invented this test. She is also very active in research for EB at a hospital in Philadelphia, Pa. It has been done and it works. There is another EB mom who decided to have more children and had this test done. Fortunately the baby did not have EB and all went well. Good luck.

Infections and Wound Dressings

A friend, Nancy has twins, 21 yrs, Katie and Kelley and shared this with me. Since it is for the good of all I want to share it also.

Regarding infections: Nancy suggested it is better to rotate topical antibiotics – gentamycin for about 3 wks to a month, then bactroban, and areas with a lot of discharge/seepage silvadene. She feels it confuses the bad bacteria, and I agree.
Some of the antibiotics you may want to mention to your Dr. are: Cipro, Cephalexin, Rifampin, Sulfa, Minocyclene, Augmentin, Vancomyacin. Cipro does not work for Jennifer. Some of these may not work on your EBer. A bath soak with epsom salts – half a quart size container to a tub of water. When there is a very stubborn infection that does not want to respond, try a vinegar bath – about a gallon of vinegar in a VERY full tub of water. Thanks to Nancy for this info.

For those of you anticipating Apligraf surgery. Jennifer had this done, and it worked about 70 % – better than nothing – right. Of course it will slough off as normal skin does, and then the bad gene will produce more bad skin – a catch 22. Here are some other options I have learned about:
We are planning to use one of these new options when the next skin graft is necessary – which appears to be soon – on her chest… : Oasis, Cook Manufacturing Company, Andy Cron, General Manager, 800-468-1379, EXT 3456, Fred Roemer, V.P.,800-457-4448 EXT 204. Mention Gary Cummings from Winfield Labs referred you – I will tell you about that in a minute.
There is a Silicon Gel Sheeting called Duo Dress manufactured to put over scar tissue to make it more soft and pliable, and possibly invisible. The only information I have regarding this is: Mark Dillon, President, BioMed Sciences, www.Silon.com I am not too familiar with this. It was mentioned to me by Gary Cummings and I have not had a chance to research this as yet. When I do, I will get back to all of you.
Of course there is the Ortec product called CCS (Composite Culture Skin), which FDA has just approved for use in the U.S. That is the product I am leaning toward for the next graft Jenn has.
I have been introduced to a wound contact dressing called N-terface this summer. I find it as good in a lot of ways as Mepitel, and cheaper. I am not saying Mepitel is not the best, it is just when you can’t afford it you take the second choice. They make several products and if you contact Gary Cummings, President, Winfield Laboratories, 800-527-4616. They make the N-terface and also Breakaway, which is a pad to go over the N-terface to absorb the excess seepage. Gary will send you samples I am sure. Please tell him I referred you. They are also working on a “vest” to cover a much larger area for those who need it. It is new, being introduced at the next meeting in California next week or two. He is sending me a sample. It is manufactured in China and is VERY inexpensive. These products work for Jennifer very well.
I just feel it important to share this with you all – it may work for your EBer also. Please let me know…. As most of you know Jennifer is just ending the Accutane Study at Chapel Hill – our last visit is Oct. 1 – 3. 2000. The Study will end in November. The results will follow a bit of time later as some are not finished for sometime. It does appear that FDA will approve the 5 year study. Soon as I can I will post from the results from the start of the Study in March to the end.

Blisters on the bottom

For Blisters on the bottom I suggest using a product called MEPILEX. It does have a sticky side which goes onto the wound. It will not stick to the wound, but will around the “good” skin. It comes off very easily with no damage. It will absorb the “seepage”, and can stay on until it is completely saturated. If it becomes saturated it will come off by itself. Instead of wrapping between the legs like a “vest”, we now use HYAFIX. It is the only type of tape we can use. It will come off very easily if you take a 4 x 4 (non-sterile), saturate it will alcohol and ease the tape off. The little bit of alcohol will not hurt the skin, just don’t get it on the wound. Place the MEPILEX on the wound and surrounding area about 1″, place about 2 – 4 x 4’s (sterile) over that, take the HYAFIX tape and criss cross it over the 4 x 4’s, just enough onto the “good” skin to hold it in place. Leave it on until the seepage comes onto the 4 x 4’s. You can also put your topical antibiotics onto the MEPILEX. Just keep it away from the outer edges so it will stick to the skin. If you put the anti close to the edges the MEPILEX will slide off the wound. The MEPILEX will act like a cushion and protect the wound. Try it, you’ll like it… 🙂 Also, for those of us who do not use MEPILEX, or prefer to use something else: in the past we have also used VISCOPASTE (this is gauze saturated with zinc oxide, and also MEPITEL. In this case, we cover the MEPITEL and/or VISCOPASTE with a sort of sponge called ALLEVYN, before we put on the 4 x 4’s. This absorbs the exudate. This is also a good method. The VISCOPASTE was especially effective. Zinc is good. There is another product called BREAKAWAY, that has a built in padding. It is also good. The diaper will also hold the bandage in place. Also, if it gets wet or dirty, just change the 4 x 4’s, that is of course if the MEPILEX is dirty also. Gee, I don’t mean to insult your intelligence.. Well I hope this helps. When Jenn was a baby and until she came with me in 1997, she had this problem. Now she has the scars to prove it… We do keep a nursing ointment (we call it BLUE GOO) on the scars if they look like they are starting to breakdown, and it works….

Jennifer’s Experience w/Anemia

Jennifer had been going to Chapel Hill, NC to the EB Registry as she was on the pilot study for Accutane. We go every three months via Angel Flights. They do thorough lab reports on her each visit, and she is seen by Madeline Weiner and Dr. Jo-David Fine. In June, 2001 we all noticed that Jenn’s RBC (red blood count) was really dropping. At that time her Hematocrit was about 26, which is low. Originally it had been at 32, which was do-able. Normally the Hematocrit should be between 35 – 45. However, in EBers trends are very important. For example, when Jennifer’s Hematocrit was at 32, she did very well, but the Hematologist wanted it higher as there is a “leak in her bucket”. Will explain that later.

We got in touch with her doctor here in Indialantic, Fl. Doctor suggested we have her kidneys checked. Kidneys produce the erythropoietin which stimulates the bone marrow to make the red cells. The kidney doctor did a thorough exam and found the kidneys are functioning properly but we needed to see if they were producing the Erythropoietine. He referred us to a Hematologist and we saw him sometime in July. When they drew blood the first time her Hematocrit was down to 23. Very bad. The Hematologist ordered a “mid-Line” and she was given intravenous iron (ferritin) every day for two weeks. A mid-line is actually a line that is introduced through the blood vessel and goes up the arm to the shoulder area. A pic-line is the same thing, except it goes past the shoulder area and down close to the heart. With a pic-line you also need an x-ray to be sure the line is not too close to the heart. This is all done on a out-patient basis. You should not have them draw any blood from the mid/pic-line as it will clog up the line and cause a blood clot. This is not a blood transfusion. However, a blood transfusion works for some EBer’s; in this case it was not what Jennifer needed. This was done at the I.V. Therapy Lab. At the end of two weeks they drew blood again, and the Red Blood Count (RBC) had gone up, slightly, but not enough. The Hematologist then prescribed Procrit Injections (Erythropoietin) to be given – I believe this was done once a week, with blood drawn every two weeks. Procrit is a pharmacological erythopoietin and is usually used in patients with depressed bone marrow function. This is not the usual cause of anemia in EB patients and a hematological work-up should be done prior to treatment with this drug. Other causes of anemia will not be corrected with Procrit and there are risks involved with this treatment. Jennifer’s RBC and Hematocrit was coming up and the doctor suggested we continue once a week with the Procrit Injection, with blood drawn once a month to keep checking the hematocrit and rbc. Jennifer’s hematocrit is now at 37.5, which is good. There is a pronounced difference in Jenn’s energy level and her skin is really looking good. Jennifer still gets Procrit every Friday, and we see the Hematologist and have blood drawn once a month. A great description of why Jennifer may need the Procreit for a long time – maybe not every week – but every two weeks or once a month – picture a large bucket full of liquid, with a tiny pin-hole leak in the bottom of the bucket. If you do not take measurements to keep the bucket full, eventually you will empty the bucket. EBers bleed constantly – as their wounds always have some seepage, being blood or some other liquid, usually blood. So it is very important to keep that “bucket full”. 🙂

As we all know, each EBer is different. This was extremely beneficial for Jennifer and that is why we want to pass it on. It may be a good thing for your EBer. Anemia is very prominent in EB and it is so important to keep up their Red Blood Count and Hematocrit.

Anemia is caused by a various number of different causes. First you must establish what is the reason for the Anemia through a Hematologist, and then follow the advise of that doctor.

Cradle Cap

We soak the scalp for 15 minutes with Acidic Solution, and it consist of 8 O.Z of saline and 2 O.Z of White Vinegar. And then we put the Olive Oil on the scalp and below is how we do that.

We bought Olive Oil and I part Jenn’s hair where I can see the areas that are dry and I take a 4×4 sterile pad and puts some Olive Oil on it and rub it GENTLY to massage the Olive oil in her head & hair. We put it in my hair every day. If you want it to work leave the Olive oil in the hair for about One day to Two days.. Check for Order, this will give you an idea when to wash the hair or if you can leave it for another day.. If you smell an order you NEED TO WASH hair, and then put the Olive Oil in the hair again.. The scabs that form with come off, but you need to help me a little bit.. If it doesn’t come off will just a LITTLE force then leave it and put Olive Oil on it.. This method has worked for me and I am sure that it will hopefully work for you all.

Love to all

Anemia

Most patients with Recessive Dystrophic Epidermolysis Bullosa are also Anemic. Anemia in EB is caused by many factors and can become very severe if not treated.

Anemia means not having enough red cells and hemoglobin. This can occur because they’re not produced, or are being lost and destroyed. Anemia can lead to low oxygen levels, which can lead to damage to organs, including the heart.

There are three types of Anemia that effect EB patients. They are Iron Deficiency, Chronic Inflammatory and Nutritional.

 Causes of Anemia in EB patients:

Blood and iron loss from wounds – Obviously with so many wounds there is blood loss and fluid loss which can worsen anemia.

Chronic infection/inflammation – Because of chronic infections there is inflammation. Inflammation inhibits red cell production and diverts iron away from the bone marrow to the liver and spleen.

Problems absorbing iron – Due to the effects EB has on the gastrointestinal tract.

Malnutrition/Malabsorbtion of nutrients – such as B-complex vitamins, B12, B6, vitamin C, vitamin E, vitamin K, folic acid, zinc, copper and selenium which are all needed for cell formation. Due to the effects EB has on the gastrointestinal tract, nutrients are not easily absorbed.

Loss of transferrin and other proteins through wounds – Iron is transported by a protein called transferrin. Non-transferrin bound iron, known as free iron, is very toxic and can cause low blood pressure, nausea, rash, facial reddening and eventually may cause heart failure and other damage. Iron is stored in a part on a protein called ferritin.

Symptoms of Anemia

Pale skin color, weakness, decreased appetite, fatigue, shortness of breath, rapid heartbeat, palpitation, headache, irritability, lethargy, dizziness, weight loss, lowered immunity, depression, slow healing, bruising.

What to Check

First a complete blood count (CBC) must be taken. It is important to check levels regularly. A CBC checks the White cells (WBC), Red cells (RBC), Hemoglobin (Hb), Hematocrit (HCT), Mean cell volume (MVC), Mean cell hemoglobin (MCH), Differential (percent of different kinds of white cells), Platelets, and Retic count (new red cells). Also check the Sedimentation rate (ESR) for a crude measure of inflammation. And check the Iron Status (iron, iron binding/transferrin saturation, ferritin)

Signs of Anemia

Low hematocrit(HCT) – Low hematocrit may indicate Anemia, malnutrition and blood loss among other things.

Low Hemoglobin (Hb) (Hgb) – The average hemoglobin level in adult women is 12.1 to 15.1 and in adult men it’s 13.8 to 17.2. Although it is often considerably lower in RDEB patients. I myself have dropped to a 4 hemoglobin once. I am usually around an 8 hemoglobin but some EB patients can get up to normal levels with proper treatment.

Small red blood cells

Low serum ferritin (serum iron) level – The serum ferritin level is directly proportional to the amount of iron stored in the body.

High iron binding capacity (TIBC) in the blood

Treatments

Inflammation Reducing Supplements – To improve the ability to absorb nutrients, a supplement can be taken to help heal and reduce inflammation in the digestive tract.

Eat Healthy – Those with Anemia should eat foods high in iron and other nutrients.

Oral iron supplements – Oral iron can be taken, however in EB the degree of deficiency is too great for it to have much effect. Oral iron can also cause constipation. A good alternative would be an herbal iron supplement (an all natural supplement that contains herbs known to be high in iron).

Supplemental vitamins – Some important vitamins to take are:
~Vitamin B12 (100mg/day + other B complex)
~Folic Acid (1mg/day)
~Vitamin E (400 – 800 U/day)
~Vitamin C (30mg/kg/day)
~Vitamin K (1-5mg/day)

Vitamins come in chewable, powder and liquid which makes it easier for EB patients to swallow. Keep in mind that whole food vitamins absorb better than regular vitamins.

 Wound care and Treatment of infection

It is extremely important to take care of all wounds and treat any infection as best you can to reduce inflammation.If the above methods do not work, or if the patient is already severely anemic the following treatments can be done:

Intravenous iron – IV iron can help a lot and is more effective when also paired with EPO shots. Frequency of iron infusions depends on how severe the anemia is. Iron must be infused slowly and a test dose is always given first to monitor any allergic reactions. Getting IV iron is an easy procedure and usually takes a couple hours. Please ask your doctor about the risks and benefits of IV iron.

Erythropoietin (EPO) shots – Erythropoietin is a naturally occurring hormone, produced by the kidneys, which stimulates the body to produce more red blood cells. It is generally given as an injection under the skin. It usually needs to be given one to three times a week. Common names for EPO shots are Aranesp (Darbepoetin Alfa), Procrit (Epoetin Alfa). Please ask your doctor about the risks and benefits of Epo shots.

Blood Transfusion – If the iron and epo are not effective, a blood transfusion is another option. This is another simple procedure that takes a few hours. Please ask your doctor about the risks and benefits of blood transfusions.

 Terms and Definitions

Anemia – Anemia is a lower than normal number of red blood cells (erythrocytes) in the blood, usually measured by a decrease in the amount of hemoglobin. Hemoglobin is the red pigment in red blood cells that transports oxygen.

Anemia of Inflammation – This type of anemia develops as a result of extended infection or inflammation.

Chronic – A chronic condition is continuous or persistent over an extended period of time. A chronic condition is one that is long-standing, not easily or quickly resolved.

Copper – Copper is an essential trace mineral present in all body tissues. Copper, along with iron, helps in the formation of red blood cells. It also helps in keeping the blood vessels, nerves, immune system, and bones healthy.

Differential – The blood differential test measures the relative numbers of white blood cells (WBCs) in the blood. It also includes information about abnormal cell structure and the presence of immature cells.

Erythropoietin – a hormonal substance that is formed especially in the kidney and stimulates red blood cell formation.

Ferritin – a crystalline iron-containing protein that functions in the storage of iron and is found especially in the liver and spleen.

Folate (folic acid) – Folic acid is a water-soluble vitamin in the B-complex group. Folic acid works along with vitamin B12 and vitamin C to help the body digest and utilize proteins and to synthesize new proteins when they are needed. It is necessary for the production of red blood cells and for the synthesis of DNA (which controls heredity and is used to guide the cell in its daily activities). Folic acid also helps with tissue growth and cell function. In addition, it helps to increase appetite when needed and stimulates the formation of digestive acids.

Hemoglobin – Hemoglobin is the most important component of red blood cells. It is composed of a protein called heme, which binds oxygen. In the lungs, oxygen is exchanged for carbon dioxide.

Hematocrit – The hematocrit is the percent of whole blood that is comprised of red blood cells. The hematocrit is a measure of both the number of red blood cells and the size of red blood cells.

Inflammation – It occurs when tissues are injured by bacteria, trauma, toxins, heat, or any other cause. Chemicals including histamine, bradykinin, serotonin, and others are released by damaged tissue. These chemicals cause blood vessels to leak fluid into the tissues, resulting in localized swelling. This helps isolate the foreign substance from further contact with body tissues.

Iron – Iron is an important trace mineral that is found in every cell of the body, usually combined with protein. Iron is an essential mineral for humans because it is part of blood cells. About 30% of the iron in the human body is in storage to be readily available to replace any that is lost. Iron is essential to the formation of hemoglobin and myoglobin, which carry oxygen in the blood and muscles. It also makes up part of many proteins and enzymes in the body.

Iron Binding/Transferrin Saturation (TIBC = total iron binding capacity) – A test that measures indirectly the transferrin level in the bloodstream

Iron-Deficiency Anemia – Iron deficiency anemia is a decrease in the number of red cells in the blood caused by too little iron.

Malnutrition – Malnutrition means a person’s body is not getting enough nutrients. The condition may result from an inadequate or unbalanced diet, digestive difficulties, absorption problems, or other medical conditions.

Mean Cell Hemoglobin – Hemoglobin amount per red blood cell (MCH)

Mean Cell Volume – Average red blood cell size (MCV)

Nutritional Anemia – anemia (as hypochromic anemia) that results from inadequate intake or assimilation of materials essential for the production of red blood cells and hemoglobin — called also deficiency anemia

Plasma – Plasma is the liquid portion of your blood. Plasma transports water and nutrients to your body’s tissues. Plasma also contains many proteins that help the blood to clot and fight disease. Plasma is a type of lymphocyte that produces immunoglobulin (antibody) that is necessary for normal immune system function.

Platelets – Platelets are necessary for normal blood clotting (hemostasis). Most important, they aggregate (clump together) to plug small holes in damaged blood vessels. They also activate factor VIII (a component of the coagulation cascade) and release phospholipids necessary for coagulation.

Red Blood Cells – RBCs transport hemoglobin. Hemoglobin transports oxygen. The amount of oxygen body tissues receive depends on the amount and function of RBCs and hemoglobin. RBCs normally survive about 120 days in the blood. They are then removed by specialized “clean-up” cells in the spleen and liver.

Retic Count – This is a test that measures the percentage of reticulocytes (slightly immature red blood cells) in blood.

Sedimentation Rate (ESR) – ESR (erythrocyte sedimentation rate) is a nonspecific screening test for various diseases. This 1-hour test measures the distance (in millimeters) that red blood cells settle in unclotted blood toward the bottom of a specially marked test tube.

Selenium – Selenium is an essential trace element. It is an integral part of enzymes, which are critical for control of the numerous chemical reactions involved in brain and body functions.

Serum Ferritin/Iron – A test that measures the amount of iron in the blood.

TIBC – Total iron binding capacity. A blood test that measures the total iron binding capacity (TIBC) as an indirect measure of transferrin.

Transferrin – Iron ions are delivered in the blood by the protein transferrin. Each transferrin molecule can carry two iron ions.

Vitamin B6 – Vitamin B6 is a water-soluble vitamin and is part of the vitamin B complex. Vitamin B6 plays a role in the synthesis of antibodies by the immune system, which are needed to fight many diseases. It helps maintain normal nerve function and also acts in the formation of red blood cells. Vitamin B6 is also required for the chemical reactions needed to digest proteins. The higher the protein intake, the more the need for vitamin B6.

Vitamin B12 – Vitamin B12 is a water-soluble vitamin that is part of the vitamin B complex. Vitamin B12, like the other B vitamins, is important for metabolism. It helps in the formation of red blood cells and in the maintenance of the central nervous system.

Vitamin C – Vitamin C is a water-soluble vitamin that is necessary for normal growth and development. Vitamin C promotes healthy teeth and gums, helps in the absorption of iron, aids in the maintenance of normal connective tissue, and promotes wound healing. It also helps the body’s immune system.

Vitamin E – Vitamin E is a fat-soluble vitamin that acts as an antioxidant. Vitamin E is an antioxidant that protects body tissue from damage caused by unstable substances called free radicals. Free radicals can harm cells, tissues, and organs, and they are believed to be one of the causes of the degenerative processes seen in aging.Vitamin E is also important in the formation of red blood cells and it helps the body to use vitamin K.

Vitamin K – a fat-soluble vitamin that plays an important role in blood clotting.

White Blood Cells – White corpuscles in the blood. They are spherical, colorless, and nucleated masses involved with host defenses. Elevated counts can be seen in cases of inflammation and infection.

Zinc – Zinc is an important trace mineral. This element is second only to iron in its concentration in the body. Zinc plays an important role in the proper functioning of the immune system in the body. It is required for the enzyme activities necessary for cell division, cell growth, and wound healing. It plays a role in the acuity of the senses of smell and taste. Zinc is also involved in the metabolism of carbohydrates.