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DESCRIPTION
Sickle cell disease is a long-term (chronic) blood disorder that causes the bone marrow to produce red blood cells with defective hemoglobin (hemoglobin S). Normally, red blood cells are round; hemoglobin S causes red blood cells to become curved, or sickle-shaped, when they lose oxygen.
Sickled red blood cells are destroyed by the body faster than normal red blood cells. When large numbers of red blood cells are rapidly destroyed by the body, a condition called hemolytic anemia results.
Sickled red blood cells are also likely to get trapped in blood vessels throughout the body, blocking blood flow. Reduced blood flow can damage the body's organs, muscles, and bones, sometimes leading to life-threatening conditions. Areas where blood vessels are blocked can become extremely painful. These painful events (vaso-occlusive events) are one of the most common and difficult problems caused by sickle cell disease.
The defective gene that causes sickle cell disease is passed to children by their parents (inherited).
- A child born with sickle cell trait has inherited one defective gene from one parent, and a normal gene from the other parent.
- A child born with sickle cell disease has inherited two defective genes, one from each parent.
- When a child with sickle cell disease is first born, it is not possible to predict which symptoms, if any, will develop, when they will start, nor how severe they will be.
The best possible medical care for a person with sickle cell disease requires a partnership between the affected family and a team of expert health care providers. Successful treatment of sickle cell disease requires:
- Early diagnosis using infant screening (shortly after birth).
- Preventive antibiotic treatment and immunizations starting at 3 to 4 months of age.
- An aggressive pain treatment plan.
- Consultation with health care providers skilled in the care of patients of sickle cell disease. In severe cases, health care providers may recommend regular blood transfusions, drug treatment with hydroxyurea, or (rarely) bone marrow transplant.
- Because life-threatening complications can develop rapidly, families affected by sickle cell disease must know what symptoms to look for and how to respond to them.
WHO IS AFFECTED?
People whose ancestors were from Africa, India, the Middle East, the Mediterranean (Turkey, Italy, Greece), and Latin America (Cuba, South America, Central America) are more likely to inherit the gene that can cause sickle cell disease. In the United States, the disease mainly affects African Americans (1 in 600) and Latin Americans (1 in 1,000 to 1,400), Of black Americans, 8% carry the sickle cell trait.
Some people inherit one sickle cell gene and one defective hemoglobin gene of another type. This results in similar sickle cell disorders ranging from mild to severe. As a group, these disorders occur as frequently as does sickle cell disease in the U.S.
FREQUENT SIGNS & SYMPTOMS
The most common symptoms of sickle cell disease are either related to long-term (chronic) anemia or blood vessels blocked by sickled cells.
Pain symptoms related to blocked blood vessels in bones, organs, other tissues:
- Mild to moderate daily pain.
- Days to weeks of extreme pain (painful events), sometimes requiring hospitalization. In a given year, approximately 60% of people with sickle cell disease experience at least one painful event. Whereas some rarely have a painful event, others have them frequently; three or more per year is considered severe.
- Episodes of extreme pain in the hands and/or feet (hand-foot syndrome) between the ages of 6 months and 3 years.
Symptoms related to chronic anemia:
Normal red blood cells have a 120-day life span, but sickled blood cells usually live no more than 20 days. When bone marrow production of red blood cells can't keep up with sickled blood cell loss, symptoms of anemia develop. Most people who have sickle cell disease have at least mild symptoms of chronic anemia, which may include:
- Weakness.
- Tiredness (fatigue).
- Pale appearance.
- Yellowing of the skin and the whites of the eyes (jaundice).
- Shortness of breath, especially with exertion.
It can be difficult to predict what symptoms a person with sickle cell disease will develop, when they will start, or how severe they will be. However, recent research suggests that an infant younger than 1 year of age who develops severe anemia or hand-foot syndrome, or both, is most likely to have severe sickle cell disease symptoms throughout life.
CAUSES
Sickle cell disease is an inherited disorder.
Normally, a person inherits two genes that tell the body to produce normal hemoglobin A. One gene comes from each parent. People who inherit one defective hemoglobin S gene and one normal hemoglobin A gene have sickle cell trait. These people do not have symptoms of sickle cell disease, nor do their bodies make sickled blood cells. However, they can pass the defective hemoglobin S gene to their children. Sickle cell disease occurs when a person inherits one defective hemoglobin S gene from each parent. Similar sickle cell disorders occur when a person inherits a hemoglobin S gene from one parent and another type of defective hemoglobin gene from the other parent.
RISK INCREASES WITH
Risk of inheriting sickle cell disease:
- Sickle cell disease is an inherited blood disorder, passed from parent to child. In order for a child to be born with sickle cell disease, he or she must inherit two defective hemoglobin S genes, one from each parent.
People who inherit one defective hemoglobin S gene and one normal hemoglobin A gene have sickle cell trait. They do not have symptoms of sickle cell disease, nor do their bodies make sickled blood cells. However, they have a 50% chance of passing the defective hemoglobin S gene to each of their children.
If both parents have sickle cell trait, each of their children will have a 1-in-4 (25%) chance of having sickle cell disease.
If one parent has sickle cell disease (has two genes for making hemoglobin S) and the other has sickle cell trait (has one hemoglobin S gene and one normal hemoglobin A gene), each of their children will have a 1-in-2 (50%) chance of having sickle cell disease and a 50% chance of having sickle cell trait.
If one parent has sickle cell disease (two hemoglobin S genes) and the other has two normal hemoglobin A genes, each of their children will have sickle cell trait.
Risk of painful events and complications caused by sickling:
- If you have sickle cell disease, the following factors can increase the chance that your red blood cells will sickle.
Lack of oxygen due to:
- Cigarette smoke. Both smoking and inhaling smoke from other people's cigarettes (secondhand smoke) can damage the lungs and lower oxygen levels in the blood. Children and adults who have sickle cell disease should not be exposed to cigarette smoke.
- High altitude (locations at higher than 7000 feet. There is less oxygen in the air at high altitudes.
- Air travel. Because there is less oxygen at high altitudes, flying in an unpressurized airplane can cause cells to sickle. Although large passenger airplanes are pressurized, a person with sickle cell disease may have a sickling problem even when flying in a normal, pressurized airplane. Most people won't have problems if they are only flying for a short time (less than 4 to 6 hours) and drink plenty of fluids during the flight.
- Cold temperatures. Exposure to cold air and water may cause a painful event by triggering red blood cell sickling in exposed areas of the body.
- Loss of fluid (dehydration). Dehydration may slow blood flow in the body, which increases a person's chance of having a painful event.
- Infection. Painful events are commonly triggered by infection in people who have sickle cell disease.
- Stress. Increased stress may bring on painful events.
- Strenuous exercise. Dehydration and lower oxygen levels in a person's blood can result from strenuous exercise and may cause red blood cells to sickle. Many people with sickle cell disease can tolerate moderate exercise if they rest when they feel tired and drink plenty of fluids.
PREVENTIVE MEASURES
Because sickle cell disease can become life-threatening, home prevention measures are very important. You can do the following to help prevent some of the problems caused by sickle cell disease.
- Prevent severe childhood infection with daily antibiotics and possible routine immunizations.
- Make sure that your child takes regular doses of a prescribed antibiotic until age 5.
- Make sure you research out and then consider whether your child should receive all standard immunizations on schedule (including H. influenzae type B (Hib) and hepatitis B), plus pneumococcal and yearly influenza vaccines.
- Avoid dehydration to prevent sickling.
- Drink a lot of water and other fluids. Drink extra fluids during and after exertion and when in the heat. Adults with sickle cell disease need about 1 gallon (3.8 L) of fluid a day. Children should keep a water bottle with them during school, play, and outings.
- Avoid alcohol. Alcohol use can lead to dehydration.
- Avoid conditions that lower the oxygen levels in your blood.
- Avoid high altitudes. The air at high altitudes (as in an unpressurized airplane or in the mountains at altitudes greater than 7000 feet has less oxygen than at sea level. Most people won't have problems if they are only flying for a short time (less than 4 to 6 hours) on a commercial flight.
- Avoid cigarette smoke. Smoking and secondhand smoke reduce the amount of oxygen in your bloodstream.
- Manage and avoid stress. See the topic Stress Management for helpful information.
- Get plenty of sleep. Avoid fatigue.
- Avoid cold temperatures. Avoid cold air and water. Dress in layers for cold weather to avoid sudden temperature change. Cold temperatures can increase sickling and trigger a painful event.
- Get an eye exam every year to prevent eye damage or blindness. Adults and children older than the age of 10 who have hemoglobin SC disease require regular eye exams so vision problems can be detected and treated early. A health care provider who specializes in eye disease (ophthalmologist) should do this exam. An optometrist may not always perform the type of detailed eye exam required for people with sickle cell disease.
- Educate yourself.
- Learn to recognize serious symptoms. See the section When to Call a health care provider for more information about serious warning signs. Partner with your health care provider, using your experience of the disease and your health care provider's expertise. Make a plan for how to treat pain at home and when to seek medical care for severe pain and symptoms.
- Learn about proper diet and dietary supplements.
- A healthy diet helps keep the body's immune system strong. Your health care provider or a nutritionist may be a good source of information about proper diet.
- Folic acid supplements are sometimes prescribed to aid the bone marrow's production of red blood cells.
- Learn skills for pain management. Read up on skills such as distraction, guided imagery, deep breathing, relaxation, and self-talk. Consult with a pain treatment specialist in a pain clinic. Teach these skills to your child and family members, and practice them yourself to prevent family anxiety and reduce pain.
EXPECTED OUTCOME
With good medical treatment, the average person with sickle cell anemia lives to be 40 to 50 years old. Some people with sickle cell disease live past the age of 70.
POSSIBLE COMPLICATIONS
When a child is born with sickle cell disease, it is impossible to predict which problems, if any, will develop, when they will start, or how severe they will be. During the first 6 months of life, infants have a high level of fetal hemoglobin (HbF) in their blood, which protects them from red blood cell sickling. However, life-threatening complications of sickle cell disease may quickly develop between the ages of 6 months and 5 years, once levels of fetal hemoglobin decrease.
Older children and adults with sickle cell disease may experience few problems or have a pattern of ongoing complications that shorten their lives.
Complications related to blocked blood vessels (vaso-occlusion by sickled red blood cells) include:
- Painful events.
- Bone and joint damage (osteonecrosis), including hand-foot syndrome between ages 6 months and 3 years.
- Blocked blood flow to the brain, causing:
A sudden stroke. Approximately 5% to 10% of children with sickle cell disease experience a stroke after 1 year of age. Infants identified as high risk for stroke may be treated with blood transfusions to prevent a stroke.
Cognitive impairment with or without signs of a stroke, affecting approximately 20% of children with sickle cell disorders.
- Acute chest syndrome, which is caused by a combination of factors not fully understood. This condition is most frequent in children, yet more severe in adults, and can be fatal.
- Damage to organs and other tissues, including the liver and kidneys, that are deprived of blood circulation and oxygen. Damage can occur rapidly during a painful event or slowly over time. Life-threatening conditions may develop because of organ failure.
- Sudden trapping of sickled red blood cells in the spleen (splenic sequestration), most commonly in children aged 6 months to 2 years. Without emergency medical care, splenic sequestration can cause death in a matter of hours.
- Prolonged, painful erection of the penis (priapism) in both children and adults.
Complications relating to hemolytic anemia include:
- Aplastic crisis. During an aplastic crisis, the red blood cell count suddenly drops. An aplastic crisis requires immediate medical care. Some aplastic crises can lead to heart failure and death if not quickly treated with blood transfusions.
- Folic acid deficiency. Folic acid is needed to make red blood cells. Low levels of folic acid can worsen anemia. Some doctors recommend folic acid supplements for people who have sickle cell disease.
- Gallstones. Rapid breakdown of red blood cells increases the risk of forming gallstones. More than half of all adults with sickle cell disease have gallstones. Of affected children aged 2 to 4 years, 12% develop gallstones.
Other complications of sickle cell disease include:
- Severe infections, particularly in children under age 3. Children with sickle cell disease are at risk for sudden, life-threatening infections.
- Children may require standard immunizations and pneumococcal and flu shots. In addition, children under 5 need to take a daily antibiotic to prevent infection.
- Growth problems. Children with sickle cell disease often grow slower than normal and go through puberty later than children who do not have sickle cell disease.
- Open sores (ulcers) on the legs and feet, commonly during adulthood. These ulcers can be very painful and heal slowly. Some may last for years.
- Eye damage. Long-term vision problems can be caused by blocked blood flow in the inner lining of the eye (retina).
TREATMENT
GENERAL MEASURES
EXAMS AND TESTS
Prenatal testing:
Sickle cell disease can be diagnosed before a child is born (prenatally). A couple who is at risk of transmitting sickle cell disease to their offspring may choose prenatal testing.
During pregnancy, your midwife or health care provider may use amniocentesis or chorionic villus sampling (CVS) to see whether the fetus has sickle cell disease. Some couples choose to end a pregnancy if the fetus is found to have sickle cell disease.
Infant screening:
Sickle cell disease can be diagnosed at birth. Most states in the United States screen all children for sickle cell disease, along with other common disorders, when they are born. A few states only test children who are in high-risk groups.
Soon after birth, a sample of blood is taken from the infant's heel and sent to a lab, where it is screened for the presence of sickle cell hemoglobin (hemoglobin S).
Adult screening:
If one member of a couple has sickle cell disease or sickle cell trait, the other member should be tested for purposes of family planning. This test requires a blood sample, which is screened for the presence of hemoglobin S, hemoglobin C, or beta-thalassemia.
If one or both members of a couple carry a hemoglobin S gene, the couple may want to meet with a genetic counselor before becoming pregnant to learn more about their chances of having a child with sickle cell disease. For more information, ask your health care provider about genetic counseling.
Early Detection:
Sickle cell disease can be detected before birth and in newborns. Most states in the United States screen all children for sickle cell disease after birth. Some states test only those who belong to high-risk groups.
TREATMENT OVERVIEW
Successful treatment of sickle cell disease requires:
The latest prevention, treatment, and home care information for families who are affected by sickle cell disease.
A partnership between the affected family and a health care provider experienced in sickle cell disease treatment.
Diagnosis at birth, to ensure that an infant with sickle cell disease can begin life-saving treatment to prevent infections, including possible routine childhood immunizations and vaccines and daily antibiotics from 3 or 4 months to 5 years of age.
Regular health care provider visits to check for signs of organ damage.
An aggressive pain treatment plan, using pain medication, pain management skills, and hospitalization when necessary.
Immediate treatment for sudden, serious problems and complications.
For severe cases of sickle cell anemia, drug treatment with hydroxyurea, bone marrow transplants, or blood transfusions may be used. (See the Medications and Other Treatment sections in this topic for more information.)
WHAT TO THINK ABOUT
Pregnant women who have sickle cell disease require specialized medical care. This disorder is usually considered a contraindication for a home birth.
People with sickle cell disease, and their families, face ongoing stress. Painful events and serious complications of the disease can develop suddenly and unpredictably and can become life-threatening. The bouts of severe pain can last for days to weeks, are difficult to treat, and are exhausting for caretakers as well as for the person in pain. Having a community of support (such as medical professionals, extended family, friends, church, and counselors) can help ease stress and worry.
HOME TREATMENT
Treatment of pain at home is a way of life for most people with sickle cell disease. Sickle cell pain varies from person to person, from mild to severe, and from occasional to constant. Some people experience numerous painful events a year, while others experience none.
In many cases, mild to severe sickle cell pain can be treated at home. However, painful events can become severe and last for days to weeks. Such extreme pain requires aggressive pain medication that must be monitored in the hospital. If pain is increasing and is not relieved by treatment at home, call your health care provider and seek emergency medical care.
Mild to moderate body pain, some painful events, and some cases of priapism can be treated at home by doing the following.
For pain:
- Drink a lot of water and other fluids.
- Get plenty of bed rest.
- Keep warm. Cold temperatures worsen pain.
- Practice pain management skills, such as distraction, guided imagery, deep breathing, relaxation, and self-talk. These skills can help you and/or your child focus away from the pain. A pain specialist can teach you pain management skills.
- Treat the pain with medication.
- For mild pain, use ibuprofen (such as Advil) and/or acetaminophen (such as Tylenol).
- Children and teens under age 20 should not be given aspirin, which can cause Reye's syndrome.
- For more severe pain, take regular doses of pain medication prescribed by your health care provider.
- Use the pain management plan you have developed with your health care provider to help decide what type of pain medication to use. You are probably the best judge of when it is necessary to use a stronger prescription pain killer.
For priapism (Follow these home treatment tips as soon as priapism develops):
- Urinate often to avoid feeling the need to urinate. Don't wait until you feel the need to urinate.
- Take a warm bath.
- Drink as much water and other fluids as you can.
- If the pain is especially severe or the problem doesn't go away within 2 to 3 hours, seek emergency treatment.
Special needs of people living with sickle cell disease
Children and teenagers may have special needs when at school and play. Special care is necessary to avoid dehydration, fatigue, and exposure to rapid temperature change, which are triggers for complications of sickle cell disease.
SURGERY
There is no surgical cure for sickle cell disease.
The following surgeries may be done to treat problems caused by sickle cell disease:
- Removal of the spleen (splenectomy) to prevent trapping of too many red blood cells in the spleen (splenic sequestration).
- Removal of the gallbladder (cholecystectomy) to prevent problems that can be caused by gallstones.
- Surgery may be required to drain fluid from the penis in cases of severe priapism.
OTHER TREATMENT
Blood transfusions can treat some complications of sickle cell disease and prevent others. Blood transfusions may be used on an emergency basis, or regularly in severe cases, to prevent further complications.
Bone marrow transplants are an experimental treatment for sickle cell disease. They require a suitable donor and carry a high degree of risk. One in every 10 people does not survive a bone marrow transplant.
Other Treatment Choices:
Blood transfusions (regular or emergency)
Bone marrow transplant
What to Think About:
Regular blood transfusions can cause iron buildup in the body, which requires daily treatment (iron chelation) and close monitoring.
Bone marrow transplants are seldom used to treat sickle cell disease due to the high risk of complications, the low availability of matched bone marrow donors, and the experimental nature of the procedure.
PLACES TO OBTAIN HELP & INFORMATION
March of Dimes Birth Defects Foundation
1275 Mamaroneck Avenue
White Plains, NY 10605
Phone: (914) 428-7100
Phone: 1-888-MODIMES (1-888-663-4637)
Fax: (914) 997-4763
TDD: (914) 997-4764
E-mail: resourcecenter@modimes.org
Web Address: http://www.modimes.org
This organization is dedicated to the prevention of birth defects and infant mortality by providing service and support to the public and the scientific community. The March of Dimes Birth Defects Foundation can provide you with free literature and a listing of support groups in your area. Staff members at the resource center are available to answer your questions over the phone.
Sickle Cell Disease Association of America (SCDAA)
200 Corporate Point
Suite 495
Culver City, CA 90230-8727
Phone: 1-800-421-8453
Phone: (310) 216-6363
Fax: (310) 215-3722
Web Address: http://SickleCellDisease.org
The SCDAA offers fact sheets, visual aids, program manuals, books, a home study kit, films and slides, pamphlets, reprints of articles, and a sickle cell disease guide for health care providers.
NIH National Heart, Lung and Blood Institute
Division of Blood Diseases and Resources
Two Rockledge Center
Suite 10138
Bethesda, MD 20892-7950
Phone: (301) 435-0055 (NHLBI Sickle Cell Disease Scientific Research Branch)
E-mail: NHLBIinfo@rover.nhlbi.nih.gov
Web Address: http://www.nhlbi.nih.gov
This organization answers questions and provides advice, references, literature searches, and copies. They also distribute information kits, lend films, and permit on-site use of the collection. These services are free and available to anyone.
MEDICATION
Medications used to treat sickle cell disease include hydroxyurea and various pain medications.
Hydroxyurea is a drug that has been used to treat cancer and is also FDA-approved for treating sickle cell disease in adults. Hydroxyurea increases fetal hemoglobin production, which can lessen the severity of sickle cell disease. Recent research suggests that hydroxyurea is also an effective treatment for children. However, long-term studies are needed before hydroxyurea will be routinely recommended for children.
Non-prescription, prescription, and hospital-administered pain medications are commonly used to treat sickle cell pain. Pain medication may work best when combined with pain management skills.
Medication Choices:
- Hydroxyurea
- Pain medications
What to Think About:
Hydroxyurea does not cure sickle cell disease, but it can reduce the incidence of serious sickling complications. Health care providers only recommend hydroxyurea treatment for adults who have three or more painful events each year. Its use requires frequent blood tests and health care provider visits.
Pain medications:
Treatment for sickle cell disease pain varies, depending on the severity of pain and how long the pain lasts. Health professionals differ in their approaches to treating pain, as do people experiencing pain.
- Sickle cell pain is often under treated.
- Some health professionals underestimate the intensity of painful events.
- Some parents, health professionals, and adults with sickle cell disease fear that use of opiate drugs (such as codeine and morphine) will lead to drug addiction. Research suggests that drug addiction is no greater among people with sickle cell disease than it is in the general population. It is important that these drugs be used under careful medical supervision.
- An increasing number of health care providers and researchers recommend aggressive and continuous opiate pain medication for severe painful events.
ACTIVITY
Rest often until the anemia disappears.
DIET
Eat well and take prescribed supplements. Increase fiber and fluid intake to prevent constipation.
MoonDragon's Anemia Information - Holistic, Nutritional, & Herbal Recommendations
NOTIFY YOUR MIDWIFE OR HEALTH CARE PRACTITIONER IF...
Seek emergency care immediately if one or more of the following symptoms are present:
- Fever greater than 101°F (38.33°C)
- Severe cough
- Difficulty breathing or shortness of breath
- Chest pain
- Severe abdominal pain
- Repeated vomiting or persistent diarrhea
- A sudden increase in the size of your or your child's spleen (learn from your doctor how to feel your child's spleen to monitor its size)
- Increased paleness
- Lightheadedness
- Sudden onset of weakness
- Sudden onset of numbness or tingling in the hands, feet, fingers, or toes (even if it goes away on its own)
- Sudden development of poor balance and poor coordination when walking (even if it goes away on its own)
- Confusion (even if it goes away on its own)
- Garbled speech or an inability to speak (even if it goes away on its own)
- Sudden change in vision
- Severe headache
- Loss of consciousness
- Persistent erection of the penis (priapism) that lasts more than 2 to 3 hours or is extremely painful.
- Severe pain that can't be relieved with the usual prescription pain killing drugs or other pain-relief methods
Notify your health care provider if you or your child has any of the following. Your health care provider can help you determine when a visit to the health care provider is necessary.
- A painful event
- An open sore (ulcer) on the leg
- More frequent urination than usual
- If you have not been diagnosed with sickle cell disease but you have symptoms that concern you, use the Search feature to find more information on what to do about your symptoms.
Make a plan with your health care provider that includes where and when to get treatment in case of a sickle cell emergency.
Watchful Waiting:
There are some complications of sickle cell disease that may not need immediate medical attention from a health professional.
- A painful event can sometimes be treated at home, depending on the duration and severity of the pain. If pain cannot be controlled with prescription medication and pain management skills, seek emergency medical treatment.
- Persistent, painful erection of the penis (priapism) can sometimes be treated at home. If it does not go away with home treatment within 2 to 3 hours, seek emergency medical treatment.
If a visit to a health professional is not needed immediately, see home care information.
Who to See:
Seek out a health care provider who has expert knowledge of sickle cell disease. Some medical centers and hospitals specialize in sickle cell disease treatment and support. If your local medical community does not offer such an option, look for a health care provider and a pain treatment specialist who have experience in treating sickle cell disease.
The following types of health professionals can diagnose and help treat symptoms of sickle cell disease. For ongoing health care, choose a doctor who you are comfortable with and you can partner with over the long term.
- Family practice or primary care health care provider.
- Children's health care provider (pediatrician).
- Blood specialist (hematologist).
Other health professionals may become involved in treating you or your child. The following health professionals may provide specialized treatment or counseling.
- Children's health care provider (pediatrician).
- Blood specialist (hematologist).
- Pain treatment specialist.
- Lung specialist (pulmonologist).
- Nerve and brain specialist (neurologist).
- Eye specialist (ophthalmologist).
- General surgeon.
- Nurse.
- Genetic counselor.
- Medical social worker.
- Psychologist, clinical social worker, counselor, or family therapist.
- Other specialists as needed.
Nutritional Supplements for Anemia
These are nutritional suggestions for treating general anemia. Some of these suggestions may not be appropriate for your situation. Consult with your health care provider or nutritionist before beginning any nutritional supplement or dietary program. Your health care provider will be familiar with your particular situation and will help you design a lifestyle dietary program for you to follow.
Nutrients Supplement Suggested Dosage Comments Essential Raw liver extract 500 mg twice daily. Contains all the elements needed for red blood cell production. Use liver from organically raised beef. Consider injections (under a health care provider's supervision). Blackstrap molasses Adults: 1 tablespoon twice daily.
Children: 1 teaspoon twice daily.See above under Holistic Recommendations. Folic acid 800 mcg twice daily. Needed for red blood cell formation. Biotin 300 mcg daily. Needed for red blood cell formation. Iron As prescribed by a health care provider. Take with 100 mg vitamin C for better absorption. To restore iron. Use ferrous gluconate form. Caution: Do not take iron unless anemia is diagnosed. Floradix Iron Plus Herbs from Salus Haus 2 teaspoons daily. Contains a readily absorbable form of iron that is nontoxic and from a natural source. Vitamin B12 injections 2 cc once weekly or as prescribed by health care provider. Essential in red blood cell production and to break down and prepare protein for cellular use. Injections (under health care providers supervision) are best. If injections are not available, use lozenge or sublingual form for best absorption. Or vitamin B12 2,000 mcg 3 times daily Essential in red blood cell production and to break down and prepare protein for cellular use. Injections (under health care providers supervision) are best. If injections are not available, use lozenge or sublingual form for best absorption. Vitamin B complex 50 mg 3 times daily. B vitamins work best when taken together. A sublingual form is recommended. Pantothenic acid (vitamin B5 50 mg 3 times daily. Important in red blood cell production. Vitamin B6 (pyridoxine) 100 mg daily. Involved in cellular reproduction. Aids absorption of vitamin B 12. Vitamin C 3,000-10,000 mg daily. Important in iron absorption. Brewer's yeast As directed on label. Rich in basic nutrients and a good source of B vitamins. Copper 2 mg daily. Needed in red blood cell production. Note: If more zinc is used, increase copper proportionately. Zinc 30 mg daily. Do not exceed this amount. Needed to balance with copper. Raw spleen glandular As directed on label. See Glandular Therapy for more information. Vitamin A 10,000 IU daily. Important antioxidant. Plus natural beta-carotene 15,000 IU daily. Important antioxidant. Or carotenoid complex (Betatene) As directed on label. Important antioxidant. Vitamin E 600 IU daily. Take separately from iron supplements. Important for red blood cell survival; prolongs the life span of these cells. Use emulsion form for better assimulation.
ANEMIA SUPPLEMENTS & PRODUCTS
Information for help with anemia, a condition that occurs when either the number of red blood cells or the amount of hemoglobin in the blood is reduced.
Iron Ionic Mineral Supplement, Fully Absorbable, 20 +/- ppm - 16 fl. oz.
WaterOz Ionic Iron is a pure liquid Iron supplement. Iron is called the "energy giver." It attracts oxygen and builds blood. Along with manganese and copper it is necessary for healthy blood chemistry and is essential for recovery from illness.Appetite Stimulant Formula Tincture, 100% Organic - 2 fl. oz.
This herbal appetite stimulant has been designed by a Master Herbalist to stimulate the appetite. It combines herbs well known, and recommended by the German Commission E, for improving the appetite and eliminating symptoms of appetite loss.Iron Complex w/ Vitamins & Herbs, Vegetarian Formula, NOW Foods - 250 Tabs
Iron is part of myoglobin, which helps muscle cells store oxygen - iron-deficient people tire easily in part because their bodies are starved for oxygen and without enough iron, ATP (the fuel the body runs on) cannot be properly synthesized so, as a result, some iron-deficient people become fatigued even when their hemoglobin levels are normal.St. John's Wort, Perika, 300mg - 60 Tabs
Nature's Way St. John's Wort is scientifically advanced to maintain a healthy emotional outlook.Folic Acid (Vitamin B-9) 100% Natural, Nature's Way 800mcg - 100 Caps
Folic acid (Vitamin B-9) is necessary precursor for the manufacture of genetic material like RNA and DNA. It also assists in the growth and repair of tissues and in the conversion of fats and amino acids into other useful products in the body.Brewers Yeast, NOW Foods 650mg - 200 Tabs
Brewer's Yeast has been shown to help people having difficulty sleeping, fatigued, and diarrhea caused by Clostridium difficile.Alfalfa Leaves, Nature's Way, 405mg - 100 Caps
Nature's Way Alfalfa Leaves are organically grown by Trout Lake Farm, Washington, and Certified Organically Processed in accordance with Oregon Tilth standards and the California Organic Foods Act of 1990.Bilberry Extract Tincture, 100% Organic - 2 fl. oz.
Helpful with many different diseases of the eyes including vascular retinal disturbances, cataracts, diabetic-induced glaucoma, myopia, and all forms of eye strain.Black Cherry Fruit Extract 750mg NOW Foods - 90 Vcaps
Black Cherry extract or Black Cherry concentrate has been found to prevent attacks of gout. Black, sweet yellow, and red sour cherries have all shown to be effective.Dandelion Root Tincture, 100% Organic - 2 fl. oz.
Dandelion root is a natural diuretic and improves appetite and minor digestive problems. Dandelion leaves are commonly recommended as a food supplement for pregnant and postmenopausal women.Goldenseal Root Tincture (Hydrastis canadensis), 100% Organic - 2 fl. oz.
Uses include Adrenal Glands; Eye Problems; Fainting; Gallbladder; Gallstones; Nephritis; Pancreatic Disorders; Peritonitis; Poison Ivy/Oak; Prostate Problems; Psoriasis; Pyorrhea; Quinsy,;Scarlet Fever; Spinal Meningitis (sometimes referred to simply as Meningitis); Spleen; WoundsPau D Arco (Purple Lapacho), Inner Bark 545mg - 180 Caps
Pau d'arco is a South American herb which helps strengthen and nourish the body's defense system. A healthy immune system is a key in fighting diseases and infections.Red Raspberry Leaves, 480mg - 100 Caps
Red raspberry leaf strengthens the uterus wall and regulates menstrual flow. It nourishes the reproductive organs, especially the uterine muscles, and helps strengthen and prepare the body for childbirth. It is also highly valued for its soothing and astringent properties to the stomach and intestinal tract.Maca (Lepidum meyenii) Tincture, 100% Organic - 2 fl. oz.
Today Maca is used to increase energy and support the immune system. Maca can help a number of conditions from fatigue to frigidity.Instant Energy B-12 (2,000 mcg of B-12 per packet), NOW Foods - 75 Packets
NOW® Vitamin B-12 Instant Energy is the perfect way to keep alert and energized, regardless of the situation. These convenient, fast-acting packets are perfect when traveling or for convenience.Vitamin C 1000 with Bioflavonoids, Nature's Way, 100% Natural, 1000mg - 250 Vcaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.Meta C Vitamin C Supplement, 1000mg - 100 Tabs
Meta C Vitamin C Supplement is a unique form of vitamin C that is absorbed faster than regular vitamin C and maintains higher serum levels for longer period of time with no intestinal discomfort.Vitamin C Liquid, with Rose Hips and Bioflavonoids, Kosher, Natural Citrus Flavor, 1000mg - 16 fl. oz.
Liquid Vitamin C with Natural Rose Hips & Bioflavonoids is an easy to swallow dietary supplement that exceeds the recommended daily intake of vitamin C.Nettle Tincture, 100% Organic - 2 fl. oz.
Nettle leaf has become a popular treatment of allergies (hay fever) and it can improve goiter, inflammatory conditions, and arthritis.Amalaki (Dhatri), 100% Natural, 450mg - 120 VCaps
Amalaki is an Ayurvedic effective against allergies, anemia, cold & flu, constipation, diabetes, digestive disorders, and liver problems.Copper Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm - 16 fl. oz.
WaterOz Ionic Copper is a pure liquid Copper supplement. Copper influences protein metabolism and general healing, improves vitamin C oxidation and is integral in the formation of RNA.Vitamin B-12 (Cobalamin), 50mcg & B-9 (Folic Acid), 400mcg - 1 fl. oz.
Vitamin B-12 (Cobalamin) helps to maintain a healthy nervous system and helps in the prevention of pernicious anemia.Heart Formula Tincture, 100% Organic - 2 fl. oz.
The Heart Formula can be used for anemia, fatigue and heart problems.Spleen & Pancreas Formula Tincture, 100% Organic - 2 fl. oz.
Use the Spleen & Pancreas Formula to strengthen and nourish the spleen and pancreas naturally.Dong Quai Root Tincture, 100% Organic - 2 fl. oz.
Dong Quai root is often used in the treatment of menstrual cramps, or dysmenorrhea and PMS, hot flashes, and other menopausal symptoms.Once Daily Multi Vitamin & Mineral, All Natural, Lactose Free, w/ Iron - 100 Tabs
Nature's Way Daily Multi Vitamin & Mineral provides many of the essential nutrients that modern diets may lack. They are useful for protection, growth and maintenance of body systems as they age.Alive! Whole Food Energizer Multi Vitamin with Mineral, Nature's Way 18mg of Iron added - 90 Tabs
Alive Whole Food Energizer Multi Vitamin with Mineral with Iron by Nature's Way is absorbed into your blood stream 5 times faster than other leading brands.Ester C with Bioflavonoids, 25% More Free, 500mg / 200mg - 150 Vcaps
Nature's Way Ester C with bioflavonoids is 100% natural calcium ascorbate with biologically active metabolites. These metabolites enhance cellular uptake and retention of Vitamin C. Now get 25% more free.Vitamin C Liquid, with Rose Hips and Bioflavonoids, Kosher, Natural Citrus Flavor, 1000mg - 16 fl. oz.
Liquid Vitamin C with Natural Rose Hips & Bioflavonoids is an easy to swallow dietary supplement that exceeds the recommended daily intake of vitamin C.Barberry Tincture, 100% Organic - 2 fl. oz.
Barberry is used for treating gallbladder disease, heartburn and indigestion and diarrhea. This herb can also be used to treat infections, parasites, psoriasis, and vaginitis.Cocoa Powder - Certified Organic 100% Natural
From holiday desserts and everyday baking, to a steaming cup of hot cocoa on those cold winter days, NOW® Organic Cocoa Powder offers a guilt-free way to satisfy your sweet tooth without the high amounts of sugar, fat and preservatives common to many commercially available mixes.
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