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As we saw in chapter one, the protein erythropoietin which stimulates the marrow to produce new red cells is produced in the kidneys. The kidney produces erythropoietin on an as needed basis whenever the number of red cells in the body falls. But people with kidney disease can’t produce enough erythropoietin to trigger red cell production when needed, so they often end up with severe anemia.

Using a therapy called recombinant human erythropoietin; physicians are now able to treat the anemia caused by chronic kidney disease. In the past, the more than eighty thousand Americans with this type of anemia many of whom undergo kidney dialysis were dependent on transfusions. Now biotechnology companies produce erythropoietin in the laboratory using techniques of genetic engineering. Genetically engineered erythropoietin which is chemically identical to erythropoietin produces erythropoietin the laboratory using techniques of genetic engineering. Genetically engineered erythropoietin which is chemically identical to erythropoietin produced in the body is infused into the body several times a week. In most cases it cures anemia (but not kidney disease) and eliminates the need for blood transfusions.

Some species of bacteria are prone to develop drug-resistant mutants. Not only may treatment of the individual prove ineffective, but such organisms may then pass to a previously uninfected patient and cause disease which will not respond to chemotherapy. For instance the streptococcus was susceptible to disulphide when these drugs were first introduced. After several years, resistant strains became so numerous that gonorrhea was resuming its previous severity until the discovery of penicillin and now this drug is sometimes ineffective. Of even grater importance are staphylococci, many strains of which were at one time susceptible to penicillin and to various antibiotics but which have now become resistant to the action of most chemotherapeutic agents.

Now comes the fun part embarking on the great adventure of planning meals so you get all the iron, foliate and vitamin B12 you need to prevent deficiencies. Relax and red through the next sections carefully for simple tips on shopping, storing and preparing foods in ways that preserve their nutritional content. You should also discuss the recipes and suggested menus with your doctor to make sure they are appropriate for you. Then enjoy the tasty meals on the pages that follow two full weeks of menus, one week with meals that follow two full weeks of menus, one week with meals that contain red meat, one week of meals that don’t require any special cooking equipment other than an occasional pot or pan. Best they meet an adult’s requirements for all nutrients, not just iron, foliate and vitamin B12 You’ll learn how to adapt the menus and use the food lists in the section Meal Planning Tips on page 83 But first let’s go shopping “Color and freshness are the key words to remember when shopping for foods rich in iron, foliate and vitamin B12. Here are some rules of thumb.

The donor marrow is transfused into the recipient. This is done by placing the marrow into a blood beg and running it into a vein, just like a blood transfusion. The donor marrow cells find their way through the circulatory system into marrow cavities in the recipient’s bones. There they begin to grow. After a bone marrow transplant, you remain in the hospital for up to six weeks to give your marrow time to produce new cells especially white cells, which protect the body from infection and disease. The risk of developing an infection is very high during the recuperation period after a bone marrow transplant. Another risk is graft versus host disease (GVHD) this happens when white cells from the donor marrow recognize their new host (the person who received the transplant) as foreign territory and begin attacking the body’s cells and tissues. Symptoms of GVHD include rash, diarrhea, and jaundice. Drugs that suppress the immune system, temporarily inactivating white cells, are used to prevent or treat GVHD.

Bone marrow transplant offers an opportunity of complete cure for a plastic anemia and certain types of hereditary anemia. However, it is an expensive and risky procedure. It also depends on the availability of a suitable donor, who is not always easy to find. The type of none marrow transplant used to treat severe anemia is called allergenic meaning it depends on a donor whose blood and tissue types are very similar to or almost exactly like those of the person receiving the transplant is a brother or sister. During a bone marrow transplant, healthy marrow is taken from the donor and used to replace damaged marrow in the anemic person. Here’s a simplified view of how the procedure works; in the first step, space is made in your bones for donor marrow. This is accomplished by destroying your red marrow with drugs (chemotherapy) or radiation. This is dangerous because all marrow cells are destroyed, not just red cells. So infection of any sort can become life threatening during this time. The second step involves taking marrow from the donor’s hip or sternum bones. To do this the donor is put under general anesthesia and the marrow is sucked out using hollow aspiration needle Only a small amount is needed 20 ml to 50ml the equivalent of an ounce or two because new marrow grows very quickly in the bone of the recipient.

The academy concluded that there are four periods of life when iron deficiency is particularly common, and the RDAs reflect the need for more iron during these periods of increased demand:

1. From age six months to our years, children are at risk of becoming iron-deficient because the iron content of milk – their main food – is low, but the body is growing rapidly, so iron stores are quickly depleted.
2. During adolescence, more iron is needed to meet the requirements of rapid growth.
3. During the reproductive years for tens and women more iron is needed to replace blood lost during menstruation.