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The anemia that results from deficiencies of vitamin B12, folic acid (see Chap. 41), or iron (see Chap. 42) are, in general, clearly defined and are relatively common. In contrast, the characteristics of anemia that may occur with deficiencies of micronutrients, such as some of the other vitamins and minerals, are poorly defined and relatively rare in humans. When present, they exist not as isolated deficiencies of one vitamin or one mineral but rather as a combination of deficiencies. In this context, it is difficult to deduce which abnormalities are a result of which deficiency. Studies in experimental animals may not accurately reflect the role of micronutrients in humans. Accordingly, our knowledge of the effect of many micronutrients on hematopoiesis is fragmentary and based on clinical observations and interpretations that may be flawed. The daily requirements of some of the micronutrients are available at http://www.nal.usda.gov and the levels normally found in the serum, red cell, and leukocytes are shown in Table 43–1.

Table 43–1. Blood Vitamin and Mineral Levels (Adult Values)

Acronyms and Abbreviations

Acronyms and abbreviations that appear in this chapter include: MCV, mean corpuscular volume.

Vitamin A Deficiency

Chronic deprivation of vitamin A results in anemia similar to that observed in iron deficiency.1–4 Mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC) are reduced. Anisocytosis and poikilocytosis may be present, and serum iron levels are low. Unlike iron-deficiency anemia but similar to the anemia of chronic disease, the iron stores in the liver and marrow are increased, the serum transferrin concentration usually is normal or decreased, and administration of medicinal iron does not correct the anemia. The suggestion that vitamin A may facilitate iron absorption5 has not been confirmed.6

Surveys conducted in developing countries suggest that vitamin A deficiency represents a public health problem among schoolchildren.7,8 The prevalence of vitamin A deficiency closely coincides with the prevalence of iron deficiency in this demographic setting. However, there is no known casual relationship between the two nutrients beyond both occurring in a setting of generalized malnutrition. Although vitamin A deficiency is recognized to occur in the United States, the relationship between ...

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