Despite recent advances in the management of sickle cell disease (SCD) through improved care [1,2] re-induction of fetal hemoglobin synthesis [3,4] and bone marrow transplantation [5] the condition nonetheless frequently causes major morbidity and early death.[6,7] In addition, SCD has an enormous impact on the public health systems in the countries where the beta^S gene occurs in high frequency, reflecting the significant investment required for patient care.

Table 1. Prenatal Diagnostic Techniques for Hemoglobinopathies
Sample Source	Fetal Risk	Analysis	Current Status
Fetal Blood	1-2%	Hemoglobin Separation	Obsolete
Amniotic Cells	>0.5%	DNA	Clinically Available
Trophoblastic Cells	>0.05%	DNA	Clinically Available
Fetal Cells in Maternal Circulation	0%	DNA	Investigational

Consequently, prevention of the disease through carrier identification, genetic counseling, and prenatal diagnosis remain the only realistic approach to diminish the impact of the disease and allow better use of available resources for the existing patient populations.[8-10] In this context, prenatal diagnosis offers a choice to couples at risk of having children with SCD. Certainly, the solution is far from ideal, and entails numerous moral, legal, technical, and financial issues. However, until gene therapy or other approaches can cure or significantly improve the clinical impact of this condition, prenatal diagnosis is the sole option available to many couples who wrestle with the issue of having children affected by SCD.

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APPROACH TO THE POPULATION & ACCEPTANCE OF THE PROCEDURE

Indications for prenatal diagnosis of SCD include a potential outcome of homozygous SCD (one beta^S gene on each chromosome) or compound heterozygous states with the beta^S gene on one chromosome and beta-globin chain defects such as HbC, HbD, and the severe beta-thalassemias on the other. The latter group comprises the beta⁰ thalassemia genes (mainly the beta⁰ CD39 and IVS1-nt1 mutations) which completely abolish beta-globin chain synthesis, as well as the beta⁺ IVS1-nt 110 genotype which severely curtails beta-globin production.[11]

Couples at risk for these conditions may request prenatal diagnosis if there is:

1. Retrospective identification of the beta^S trait in couples who have an affected child.



2. Retrospective identification of the carrier state in parents as a result of the diagnosis of an affected newborn at birth by examination of cord or neonatal blood.[12-16]



3. Prospective examination after information sent by mass media or school.



4. Prospective voluntary examination in the context of population screening.[17-19]



5. Prospective mandatory blood examination in the Army, school, or other organization.

The feasibility of population screening depends mainly on the economic resources of the country, the sensitivity and education level of the population group at risk, and the availability of appropriate laboratories. Population screening is not an issue in many heavily afflicted parts of the world because of the early death of homozygous babies.[21] The issue emerges, however, where improved care allows children to survive the initial difficult years of life. Then the parents are likely to seek carrier testing before birth of another child.[22] When the incidence of the beta^S gene is relatively high, universal premarital or antenatal population screening is justified (e.g. Cuba and Guadalupe).[23,24] Unfortunately, logistical problems often make implementation difficult in regions where it is most needed, such as Africa, Brazil and India. Inadequate speciality services for sickle cell disease can hinder selective premarital or antenatal screening when parents from groups with a high incidence of the beta^S gene immigrate to countries where the variant is rare (e.g. France, Germany, and the United Kingdom)[15,25-28] In addition, selective examination of a group of people who commonly carry a harmful gene can create perceptions of discrimination.[20] In the U.S., most states require neonatal testing by cord blood or heel prick.[12-16]

When at-risk populations harbor genes for both the beta^S and beta-thalassemia in high frequency, universal prospective carrier identification in adults is the approach of choice (e.g. Greece, Southern Italy, Arab nations, and India).[17,18] Other factors that influence the compliance of prospective parents with carrier identification efforts include religious, political, and societal views of the subjects, as well as the availability of prenatal diagnosis. In fact, the latter factor played the major role in the implementation of carrier identification programs published to date.[29-31]

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COUNSELING

When both partners carry the beta^S gene, genetic counseling can offer the following alternatives: (a) abstinence from childbearing, (b) assumption of the risks, (c) pregnancy with the option of prenatal diagnosis, and (d) in recent years - selection of a non-beta^S embryo ex vivo that is implanted into the mother's uterus. The importance of proper counseling cannot be overemphasized. Ideally, counseling should be non-directive, enabling the partners to understand the probabilities, limitations, and potential consequences of the options. The final decision rests with the couple at risk.

Acceptance of prenatal diagnosis for SCD differs from that reported for thalassemia. Influences include the mode and time of carrier identification; the age, education, religion, and national background of the prospective parents; the experience of having cared for or lost a child with SCD; the timing and effectiveness of genetic counseling; the attitude of the community; and the available medical resources. Reliable obstetric services are paramount. However, the key factor to increasing acceptance of prenatal diagnosis has been the early timing of the procedure. Women who were tested in the second trimester had difficulty with pregnancy termination in the 20^th week or later. Earlier fetal diagnosis and selective abortion have become simple, reliable, and safe and have contributed to the wide acceptance of prenatal diagnosis of SCD.

Another decisive factor is the experience of having a child with SCD, which often convinces couples at risk to seek prenatal diagnosis. In the UK, prenatal diagnosis was offered to a group of unselected women attending the obstetric clinic of a hospital in London after detection of the trait. The option was also presented to another group of women at the clinic who had an affected child. The unselected women were not sufficiently motivated to present for testing in a timely fashion, to bring their partners for testing, and were less likely to proceed to prenatal diagnosis (22 percent). In contrast, almost all women in the second group had their partners tested and requested prenatal diagnosis if their partners bore the beta^S gene.[32] In Guadalupe, where most beta^S carriers are identified after examination of the cord blood, 64 out of 144 mothers at risk for having beta^S/beta^S children (44 percent) elected to have prenatal diagnosis. Of these, only 16 out of 27 given unfavorable news (59 percent) proceeded to termination of pregnancy. The respective percentages for 41 women at risk for the beta^S/beta^C combination were 34 percent and 60 percent.[22] In Nigeria, where identification of carriers is limited to women who have had one or more affected children (retrospective screening), almost all 263 women at risk requested prenatal diagnosis. However, only 63 percent of those given an unfavorable diagnosis chose to terminate pregnancy, due most often to religious convictions or fear of the obstetrical procedure.[32] Greece has a national program to identify carriers of inherited hemoglobin disorders at school age or before marriage. Women screened in this program are twice as likely to have a child with beta^S / beta-thalassemia as the beta^S/beta^S combination. Each year nearly all 60-80 women at risk for SCD seek prenatal diagnosis, and undergo selective abortion in the case of unfavorable results.[18,33]

In Cuba, a national program offers carrier identification to all pregnant women seen in antenatal clinics, and enrolls about 300 couples at risk annually (one third for the beta^S/ beta^S and two thirds for the beta^S/beta^C combination). Out of 343 evaluated couples tested during the years 1984 to 1989, 75 (22 percent) had split marriages (7 related to genetic risk). Of the remaining 268 stable couples, 52 (19 percent) proceeded to pregnancy, while the rest decided to have no more children, (a) because they already had the number of children they wanted, (b) because of the fear of giving birth to an affected child, or (c) because of the fear of the obstetrical procedure. Of the women proceeding to pregnancy, 46 sought prenatal diagnosis (12 with an affected child), while 6 others (all with low education levels) declined this offer.[23]

Termination of pregnancy when the fetal test results are unfavorable depends on the personal beliefs of the involved couples as well as the timing of the test. In a large U.S. study, only half of the women with a positive fetal diagnosis elected to terminate pregnancy when this was offered at the 17-20^th. The number was much higher when the diagnosis was provided earlier (10^th week) through improved diagnostic techniques.¹⁹ The degree of involvement of the prospective father also played a role in the decision. Furthermore, appropriate counselors whose origin and language are similar to those of the couple at risk and the views of the community with regard to racial discrimination and stigmatization powerfully influence decisions about pregnancy termination.

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OBSTETRIC ASPECTS

FETAL BLOOD

Initially, prenatal diagnosis of SCD was performed on a small amount of fetal blood aspirated from the placenta, umbilical cord, or even fetal heart, either blindly, with ultrasound guidance, or through a fetoscope at the 20^th week of pregnancy.[34-38] The procedure was followed by blood analysis described below, but was associated with 1-2 percent fetal loss plus other complications. Also, the mid-trimester diagnosis of an affected fetus often led to a painful abortion. The complexity of this approach prevented its large scale implementation in countries such as the U.S. and Britain. The largest series of cases is from Greece where 170 prenatal tests on fetal blood, mostly at risk for beta^S/ beta-thalassemia (26 percent affected), were performed successfully from 1977 to 1985.[18]

FETAL DNA

The introduction of molecular DNA techniques that allow accurate fetal diagnosis in the first trimester and termination of pregnancy, if indicated, not later than the 12^th week of gestation changed the picture dramatically.

AMNIOTIC CELLS

Use of amniotic cells was the easiest approach to DNA analysis, even though they provide reliable results only after the 17^th week of pregnancy. Aspiration of amniotic fluid with a long needle is relatively painless and safe. About 20 ml of fluid contain enough amniotic cells for extraction of up to 20 ug of DNA, which is more than enough to identify the defect by PCR. The amniotic cells also can be expanded by in vitro culture if needed. The risk of fetal loss is lower than 0.5 percent.[17,18]

TROPHOBLASTIC CELLS

Trophoblasts derive from the trophoectoderm, which is the outer wall of the blastocyst before implantation. From the 2^nd week of pregnancy, this structure develops villi which grow across the outer surface of the chorion. By the 8-10^th week, the villi form the placenta at the implantation site and gradually disappear on the opposite side until the process is complete by the 14-15^th week. These villi, which will be lost anyway, can be biopsied with no apparent harm to the ongoing pregnancy. Chorionic villi sampling (CVS) can be performed transcervically or transabdominally.[41] Transcervical aspiration can be carried out blindly, under direct visualization, or with ultrasound monitoring. The risk of infection is greater with this approach, however. Ultrasound monitoring has made transabdominal CVS as effective and less risky. The procedure requires no anesthesia since it usually produces only mild pain. Prenatal diagnosis by CVS has a risk-rate for fetal loss or malformations of around 5 per 10,000 cases.[42,43]

FETAL CELLS IN THE MATERNAL CIRCULATION

This still experimental approach aims to spare mothers at risk from an obstetric procedure. Fetal cells present in the maternal circulation can be tagged with appropriate antibodies and collected by either fluorescence-activated or magnetic sorting. The nuclei are microdissected, and the DNA is extracted for analysis. The technique has produced prenatal diagnosis in two pregnancies at risk for sickle cell disease and thalassemia.[39,40]

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LABORATORY ASPECTS

FETAL BLOOD

Isoelectic focusing (IEF), high performance liquid chromatography (HPLC) or variations of these techniques can detect sickle hemoglobin in fetal blood.[44-47] When a sample contains solely fetal blood, the heterozygous condition reveals a major fraction of HbF (80-90 percent) and equal amounts of HbA and HbS that are easily identified. In contrast, homozygous normal and homozygous HbS fetuses will display either HbA or HbS only, respectively. When a mixture of placental and maternal blood is present, the latter red cells (and reticulocytes) can be eliminated by selective hemolysis.[48] The remaining cells can be used for globin biosynthetic studies. Today, this approach has been replaced by DNA techniques, except in the rare case when the thalassemic component cannot be identified at the molecular level.

CHORIONIC VILLI OR AMNIOTIC CELL DNA

DNA extraction. Maternal decidua contamination of trophoblastic tissue must be avoided categorically. Failure to do so can produce catastrophic errors.

Identification of the B^S mutation at the DNA level. Early work used a Hpa I restriction fragment length polymorphism (RFLP) to distinguish beta^A-globin and beta^S-globin genes.[49-51] The current method of choice employs the polymerase chain reaction (PCR) to amplify the mutated region (CCT GAG GAG to CCT GTG GAG, codons 5-7) for diagnosis. There are two main approaches:

Oligonucleotide hybridization

This technique involves using a synthetic, labeled oligonucleotide (about 20 kilobases long) that binds specifically to the CCT GTG GAG sequence under stringent conditions, but not to the sequence CCT GAG GAG. The reaction is carried out on a membrane using a drop of PCR product. The binding is shown by probes tagged with radioactive isotopes or enzymatic chromogens. The literature contains several variation of this approach.[52-54] Cross-checks with control probes, e.g. the beta^A sequence, are required.

Analysis of restriction endonuclease site

In the past, identification of the mutation by the absence of a restriction endonuclease site was carried out by the Southern blot technique on extracted DNA. The lost cleavage site produces a larger RFLP fragment.[55-56] Now the technique is used on the PCR amplification product, with the enzyme Mst II, which cuts the normal CCT-GAG-GAG sequence in two DNA fragments, 228 and 202 bp long. The enzyme cannot cleave the mutant sequence, CCT-GTG-GAG, and yields a single 430 bp DNA fragment.[57] Other enzymes that recognize the CCTGTGGAAG mutation are Dde I and Bsu 361 (an isoschizomer of Mst II).[58,59]

Misdiagnosis can occur for many reasons. The most serious is inadequate isolation of the fetal sample from contaminating maternal tissues, which can lead to misinterpretation, particularly with PCR amplified DNA.[60] To avoid this problem, most laboratories use a small amount of DNA (less than 3-4 micrograms) and limit the number of PCR cycles to minimize undesirable co-amplification of traces of maternal DNA. DNA polymorphisms in the trophoblastic sample should be compared to those of the father and mother, to exclude maternal contamination. Technical failures can be reduced by using two techniques for each sample, e.g. both allele-specific hybridization and Mst II cleavage. Precautions should be taken to avoid sample mix-up in the laboratory.

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PRE-CONCEPTION & PRE-IMPLANTATION TECHNOLOGY

The discovery that PCR could detect the beta gene sequence in a single cell was published in 1990.[61] Since then, increasing numbers of laboratories have applied this technology for preimplantation diagnosis of inherited monogenic diseases. The procedure is still complicated, costly, and perhaps risky. Moreover, coordination of various disciplines is required.[62] Preimplantation selection is feasible, however, and can be offered to couples who cannot use conventional prenatal diagnosis because selective abortion is prohibited, or who already have had several abortions after diagnoses of affected fetuses. The technique can also be offered to couples for whom multiple attempts at pregnancy are risky.

Pre-conception diagnosis is carried out on the DNA of the first polar body, which is extruded upon maturation of oocytes. The oocytes are obtained after ovarian stimulation, and the polar bodies, which contain identical DNA, are aspirated into micropipettes for analysis. The procedure has been shown to not affect fertilization of the oocytes or viability of the resultant embryos.[62] A search for the defect is carried out by PCR methods, and one or more polymorphic markers usually are checked as precautions against errors. Finally, non-affected oocytes are fertilized and transferred into the uterus of the prospective mother to start pregnancy. The procedure already has been carried out on over 28 couples at risk for various single-gene disorders, that included thalassemia and sickle cell disease, and has produced 191 mutation-free oocytes. Transfer of the latter into mothers resulted in 20 successful pregnancies and birth of 19 healthy infants.[64,65]

Post-conception diagnosis of genetic diseases can be carried out on the second polar body, which is extruded after fertilization. Sequential study of both polar bodies is strongly recommended, because it increases the accuracy of the results when the first polar body reveals an heterozygous state.[66] Then the unaffected, fertilized oocyte(s) is transferred into the uterus of the prospective mother for continuation of the pregnancy.

Alternatively, pre-implantation diagnosis can be made by biopsy of the early blastomere that has few cells. The technique is not associated with harm to the fetus.[67] In a major study, nested PCR was used to detect the abnormal gene, along with two linked polymorphic markers (a short tandem repeat (STR) 5' to the beta-globin gene and HUMTH01) in order to avoid misdiagnosis due to preferential amplification or allele drop out. Three non-linked STRs were used to detect potential contamination, and identify the right embryos after selection. An overall experience was reported for 23 couples who had 37 fertilization cycles and 96 fetal transfers prior to pregnancy. The pregnancies had come to completion in 7 couples by the date of publication.[68]

CONCLUSIONS

Prenatal diagnosis is considered to be the only solution to prevent sickle cell disease all over the world. The procedure has been simplified by both obstetric and laboratory techniques, and can be carried out with safety in many countries, early enough to allow elective termination of pregnancy.

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REFERENCES

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3. Charache S, Terrin MN, Moore RD, et al. Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia; Investigators of the Multicenter Study of Hydroxyurea in Sickle Cell Anemia. N Engl J Med 1995; 18:1317-1322.
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6. Bunn HF. Pathogenesis and treatment of sickle cell disease. N Engl J Med. 1997;337:762-769.
7. Gilman PA, McFarlane JM, Huisman THJ. Natural History of sickle cell anemia: re-evaluation of a 15 year cord blood testing. Pediat Res 1976; 10:452-456.
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9. WHO Working Group. Community Control of hereditary anaemias. Bull WHO 1983; 61:6369.
10. Modell B (1998) ApoGI Project (Accessible Publishing of Scientific Information; Information Materials for Haemoglobin Disorders. Department of Primary Care and Population Sciences; University of London.
11. Voskaridou E, Kollia P, Loukopoulos D. Sickle Cell Thalassemia in Greece. Identification and contribution of the interacting b-thalassemia genes. Ann NY Acad Sci 1990; 612:508-509.
12. Garrick MD, Denbure P, Guthrie R. Sickle cell anemia and other hemoglobinopathies. Procedures and strategy for screening employing spots of blood on filter paper as specimens. N Engl J Med 1973;288:1265-1268.
13. Grover R, Shahidi S, Fisher B et al. Current sickle cell screening program for newborns in New York City. Am J Pub Health 1983; 73:249-253.
14. Harris MS, Eckman JR. Approaches to screening. Georgia's experience with newborn screening; 1981 to 1985. Pediatrics 1989;83(suppl 5): 857-858.
15. Zeuner D, Ades AE, Karnon J et al. Antenatal and neonatal hemoglobinopathy screening in the UK: review and economic analysis. Health Technot Assess 1999; 3:1:186.
16. Nagel R. Neonatal screening. Management and Therapy of Sickle Cell Disease. 3^rd edition. NIH Publication 96-2117, Rockville MD. National Institutes of Health; National Heart, Lung and Blood Institute. PHS; US Dept of Health and Human Services.
17. Cao A, Rosatelli MC, Leoni GB et al. Antenatal diagnosis of b-thalassemia in Sardinia. Ann NY Acad Sci 1990; 612:215-225.
18. Loukopoulos D, Hadji A, Papadakis M, et al. Prenatal diagnosis of thalassemia and of the sickle cell syndromes in Greece. Ann NY Acad Sci 1990; 612:226-236.
19. Wang X, Seaman C, Paik M, et al. Experience with 500 prenatal diagnosis for sickle cell disease: diseases: the effect of gestational age on affected Pregnancy outcome. Prenat Diagn 1994, 14:851-857.
20. Beutler E, Boggs DR, Heller P, et al. Hazards of indiscriminate screening for sickling. N Engl J Med 1971; 285: 1485-1486.
21. Fleming AF. 1989. The presentation, management and prevention of crisis in sickle cell disease in Africa. Blood Rev 3:18-28.
22. Akinyanju OO, Disu RF, Akinde JA, et al. Initiation of prenatal diagnosis of sickle cell disease in Africa. Prenat Diagn 1999;19:299-304.
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24. Alexandre L, Keklard L, Romana M, et al. Efficiancy of prenatal counseling for sickle cell disease in Guadeloupe. Genet Couns 1996; 8:25-32.
25. Cronin EK, Normand C, Henthorn JS, et al. Organization and cost-effectiveness of antenatal haemopglobinopathy screening and follow up in a community-based program. Br J Obst Gynecol 2000; 107:486-491.
26. De Montalembert M, Guilloud-Bataille M, Ducros A, et al. Implication of prenatal diagnosis of sickle cell disease. Genet Couns 1996; 7:9-15.
27. Dickerhoff R, Kulozik AE, Kohne E. Monitoring pregnant women from risk countries with sickle cell disease and thalassemia. Clinical aspects, screening and prenatal diagnosis. Geburtshilfe Frauenheilkd 1993; 53:215-221.
28. Lena-Russo D, Erny N, Serradimigni F, et al. Genetic hemoglobin diseases. Prevention at centers for family planning and education of maternal-child protection in Marseille. Presse Med 1996;25:151-153 (in French).
29. Modell BM, Ward RHT, Fairweather DVI. Effect of introducing antenatal diagnosis on reproductive behaviour of families at risk for thalassemia major. Br med J 1980; 1:1347-1348.
30. Dorticos-Balea A, Martin-Luiz M, Hechevarria-Fernandez P, et al. Reproductive behavior of couples at risk for sickle cell disease in Cuba. A follow-up study. Prenat Diagn 1997; 17:737-742.
31. Greengross P, Hickman M, Gill M, et al. Outcomes of universal antenatal Screening for hemoglobinopathies. J Med Screen 1999;6:3-10.
32. Durosinmi MA, Odebiyi AI, Adediran IA, et al. Acceptability of prenatal diagnosis of sickle cell anemia (SCA) by female patients and parents of SCA patients in Nigeria. Soc Sci Med 1995;41:433-436.
33. Loutradi A. Report of the activity of the Center of Thalassemia. Unpublished statistics. Athens, 2000.
34. Hobbins JC, Mahoney MJ. In utero diagnosis of hemoglobinopathies. Technique for obtaining fetal blood. N Engl J Med 1974; 2090:1065-67.
35. Kan YW, Valenti C, Carnazza V, et al. Fetal blood sampling in utero. Lancet 1974; 1:79-80.
36. Rodeck CH, Campbell S. Sampling pure fetal blood by fetoscopy in the second trimester of pregnancy. Br Med J 1978;2:728-30.
37. Fairweather DVI, Ward RHT, Modell B. Obstetric aspects of mid trimester fetal blood sampling by needling or fetoscopy. Br J Obstetr Gynaecol 1980; 3:271-7.
38. Daffos F, Capella-Pavlovsky M, Forrestier F. Fetal blood sampling via the umbilical cord using a needle guided by ultrasound. Prenat Diagn 1983; 3:271-7.
39. Bianchi DW, Flint AF, Pizzimenti MF, et al. Isolation of fetal DNA from nucleated erythrocytes in maternal blood. Proc Nat Acad Sci USA 1990; 87:3279-3283.
40. Cheung MC, Goldberg JD, Kan YW. Prenatal diagnosis of sickle cell anemia and thalassemia by analysis of fetal cells in maternal blood.
41. Antsaklis A. First trimester prenatal diagnosis by chorionic villi sampling. In: Prenatal diagnosis of thalassemia and the hemoglobinopathies. D. Loukopoulos ed., CRC Press 1988. Boca Raton Fl, pp. 132-143.
42. Hogge WA, Schonberg SA, Golbus MS. Chorionic villis sampling: experience of the first 1000 cases. Am J Obstetr Gynecol 1986; 154:1249-1952.
43. Brambati B. Lanzani A, Oldrini A. Transdominal chorionic villus sampling; clinical experience of 1159 cases. Pren Diagn 1988; 8:609-613.
44. Blouquit Y, Beuzard Y, Varnavides L, et al. Antenatal diagnosis of hemoglobinopathies by Biorex chromatography of hemoglobins. Bri J Haematol 1982; 50:7-15.
45. Dubart A, Goossens M, Beuzard Y, at al. Prenatal diagnosis of hemoglobinopathies: comparison of the results obtained by isoelectric focusing of homoglobins and by chromatography of radioactive globin chains. Blood 1980; 56:1092-9.
46. Dash S, Panourgias J, Karababa P, Loukopoulos D. Prenatal diagnosis of thalassemia by hemoglobin chromatography on Biorex. Prenat Diagn 1984; 4:11-20.
47. Gianni Am, Polli E, Giglioni B, et al. Isoelectric focusing of globin chains for antenatal diagnosis of b⁰ thalassemia. Hemoglobin 1981; 5:349-56.
48. Alter BP, Metzger JB, Yock PG, et al. Selective hemolysis of adult red blood cells; an aid to prenatal diagnosis of hemoglobinopathies. Blood 1979; 53:279-87.
49. Kan YW, Dozy AM. Polymorphism of DNA sequences adjacent to the human B-globin structural gene: relationship to sickle mutation. Proc Natl Acad Sci 1978; 75:5631-5.
50. Kan YW, Dozy Am. Antenatal diagnosis of sickle cell anemia by DNA analysis of amniotic fluid cells. Lancet 1978; 2:910-2.
51. Kazazian HHJr, Phillips JA, Boehm CD, et al. Prenatal diagnosis of B-thalassemia by amniocentesis; linkage analysis of multiple polymorphic restriction endonuclease sites. Blood 1980; 56:926-30.
52. Saikii RK, Walsh PS, Levenseon CH, et al. Genetic analysis of amplifies DNA with immobilized sequence specific oligonucleotide probes Proc Natl Acad Sci USA 1989; 17:2503-2516.
53. Newton CR, Graham A, Hepteinstall LE et al. Analysis of any point mutation in DNA with immobilized sequence specific oligonucleotide probes Proc Natl Acad Sci USA 1989; 17:2503-2516.
54. Geever RF, Wilson LB, Nallaseth HHJr, Boehm CD. Improved detection of the sickle cell mutation by DNA analysis: application to prenatal diagnosis. N Engl J Med 1982; 307:32-6.
55. Chang JC, Kan YW. A sensitive new prenatal test for sickle cell anemia. N Engl J Med 1982; 307:30-32.
56. Orkin SH, Little PFR, Kazazian HHjr, Boehm CD. Improved detection of the sickle cell mutation by DNA analysis: application to prenatal diagnosis. N Engl J Med 1982; 307:32-6.
57. Embury SH, Sharf SJ, Saiki RK, et al. Rapid prenatal diagnosis of sickle cell anemia by a new method of DNA analysis. N Engl J Med 1987; 316:656-61.
58. Gurgey A, Becsac S, Mesci L, et al. Prenatal diagnosis of sickle cell anemia using PCR and restriction enzyme Dde I. Turkish J Pediatr 1993; 35:159-162.
59. Husian SM, Kalavathi P, Anandaraj MP. Analysis of sickle cell gene using the polymerase chain reaction and restriction enzyme Bsu 361. Indian J Med Res 1995; 101:273-276.
60. Cao A, Rosatelli C. Screening and prenatal diagnosis of the hemoglobinopathies. Balliere's Clnics in Haematoology 1993; 6:263-286.
61. Monk M, Holding C. Amplification of a B-hemoglobin sequence in individual human oocytes and polar bodies. Lancet 1990; 985-088.
62. Kuliev A, Jackson L, Froster U, et al. Chorionic villus sampling safety. Report of World Health Organization/EURO meeting in association with the 7^th international conference on early prenatal diagnosis of genetic disease. Am J Obstet Gynecol 1996; 174:807-811.
63. Verlinsky Y, Retchitsky S, Verlinsky O, et al. Pre-pregnancy testing for single cell disorders by polar body analysis. Genet Test 1999; 3:185-190.
64. Xu K, Shi ZM, Veeck LL, et al. First unaffected pregnancy using pre-implantation genetic diagnosis for sickle cell anemia. JAMA 1999; 281:1701-1706.
65. Kuliev A, Retchitsky S, Verlindky O, et al. Birth of healthy children after pre-implantation diagnosis of thalassemias. J Assist Reprod Genet 1999; 16:207-211.
66. Verlinsky Y, Retchitsky S, Cieslak J, et al. Pre-implantation diagnosis of single gene disorders by two-step oocyte genetic analysis using first and second polar body. Biochem Mol Med 1997;62:182-187.
67. De Vos A, Van Steirteghem A. 2001. Aspects of biopsy procedures prior to preimplantation genetic diagnosis. Prenat Diagn 21:767-780.
68. Palmer GA, Traeger-Synodinos J, Davies S, Tzetis M, Vrettou C, Mastrominas M, Kanavakis E. 2002. Pregnancies following blastocyst stage transfer in PGD cycles at risk for beta-thalassemic hemoglobinopathies. Hum Reprod 17:25-31.

MoonDragon's ObGyn Health Information: Sickle Cell Anemia

MoonDragon's ObGyn Health Information: Sickle Cell Neonatal Screening

MoonDragon's ObGyn Health Information: Sickle Cell Pregnancy Contraception

MoonDragon's ObGyn Health Information: Sickle Cell Prenatal Diagnosis

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NUTRITIONAL THERAPY & HOLISTIC RECOMMENDATIONS FOR ANEMIA

Nutritional therapy will be dictated by the type of anemia you may have. The suggestions given here are basically for iron deficiency and folic acid anemia. Discuss your therapy options with your health care provider, midwife, or herbalist before beginning any self-help home therapy.

IRON REQUIREMENTS

The average amount of iron in the average adult male is 4 grams and in the average adult female 2.5 grams. The normal North American diet contains approximately 15-20 mg of iron per day. Most is present in meat and green vegetables; approximately 1.0 mg is absorbed each day and just about an equal amount is lost in feces and sweat.

To absorb the prescribed daily requirement of 1 mg daily of iron, you would need to ingest 10-15 times that amount. Menstruating women should take 18 mg of iron a day. Post-menopausal women should take 10 mg, and those with anemia should take 30 mg two times a day to restore sufficient iron levels.

As a result, the average adult's iron intake is in delicate balance, but is of little consequence as there is slightly more iron absorbed than lost and a store of iron is gradually accumulated. If, for some reason, the rate of iron loss increases, these stores can be depleted and an absolute iron deficiency develops. Such a deficiency requires large doses of supplemental iron to resupply the body stores and sufficient monitoring to prevent iron overload.

IMPROVING IRON ABSORPTION

Iron absorption is increased by the presence of sufficient stomach acid, glucose, fructose, some amino acids and ascorbic acid (vitamin C). These substances aid in the absorption process by either reducing ferric iron to the ferrous state or by helping bind the iron to the mucosal cell receptor sites. The established benefit of vitamin C has resulted in many iron supplements being manufactured with this vitamin present. Heme iron (iron from meat myoglobin) is 10 times more easily absorbed than elemental iron, or iron from non-meat sources. Iron absorption is decreased by the presence of phosphate, bicarbonate or bile acids. Thyroid medication and iron supplements should be taken at different times of the day.

You can help increase your body's absorption of iron by avoiding such foods as almonds, cashews and chocolate, and such drinks as coffee, tea, beer and sodas. In fact, omitting all sugar from your diet increases iron absorption. Even iron supplements can be undermined if you are also taking vitamin E, calcium, zinc or antacids. Vitamin C will also aid absorption: drinking 1 glass of orange juice each day may double the amount of iron absorbed.

DAILY REQUIREMENTS

The adult male requires approximately 1.0 mg per day, just enough to cover normal iron loss. The adult female requires approximately 2.0 mg per day, enough for daily loss and menstruation. Pregnant females require approximately 3.0 mg, enough for normal, ongoing loss and fetal requirements. Children require approximately 2.0 mg, enough for normal loss and extra to produce some residual iron stores and allow for increasing red cell mass.

Normal Iron levels are 40-150 ug/dL (female) and 50-160 ug/dL (male). Normal values may vary from laboratory to laboratory.

About 60 percent of iron in meat is poorly absorbed; this is a form called non-heme iron. Eggs, dairy products, and vegetables that contain iron only have the non-heme form. Such plants include dried beans and peas, iron-fortified cereals, bread, and pasta products, dark green leafy vegetables (chard, spinach, mustard greens, kale), dried fruits, nuts, and seeds. (One study reported that even though non-heme iron is normally less easily absorbed, people who were iron deficient absorbed 10 times the amount of non-heme iron as people with normal iron levels.)

ALERT!: Be sure that you do, indeed, have an iron deficiency before taking supplements. Excess iron can damage the liver, pancreas, heart and immune-cell activity and has been linked to cancer. Use any iron supplements under the supervision of a health care provider.

NUTRITIONAL SOURCES OF IRON Liver and lean red meats are the richest sources of iron available. These contain heme iron, the most readily absorbed form. Chicken and fish usually contain 1/3 to 1/2 the iron in red meat. Other iron rich foods are apples, apricots, asparagus, beans, bananas, leafy greens, peas, prunes, raisins, parsley, and corn. Blackstrap molasses is another excellent source of iron and essential B vitamins. Take 1 tablespoon twice daily. Also eat foods high in vitamin c to enhance absorption.

Foods For Health - Despite its popularity as an iron-rich source, spinach won't help your iron levels much. It contains oxalates, substances that actually interfere with the absorption of the iron (3 mg in 4 ounces) that it does offer. Iron Supplements - While iron supplements are an excellent source of iron, certain iron preparations can cause nausea and constipation. If you experience these unpleasant symptoms, try eating organic liver or using liquid liver extracts. They are good alternatives that contain all the essential elements needed for red-blood-cell production.

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HERBS

Alfalfa, Bilberry, Wild Cherry, Dandelion Root, Goldenseal, Grape Skins, Hawthorn Berry, Mullein, Nettle, Oregon Grape Root, Pau D'Arco, Red Raspberry, Shepherd's Purse, and Yellow Dock are good for anemia. Parsley, Amaranth Greens, and Kelp are high in iron and helpful for anemia.

An herbal mix for anemia includes: Comfrey, Nettle, Red Clover, Echinacea, Sage, Rue, Elecampane and Yarrow.

Added to this are the Bach Flower Remedies Wild Rose, Pine, and Olive. You can help further by drinking Rosehips Tea and eating some meat and plenty of green vegetables. You should consult your Herbalist if, after a course of 3 to 6 months on the anemia mix and with better habits, the symptoms return after stopping the mix. There will be other issues which need specific attention.

Herbal Remedies: Bach Flower Remedy / Essence Information & Use

Herbal Remedies: Bach Products & Supplements

For pregnancy, I have my pregnant moms drink a Pregnancy Tea consisting of:

MOONDRAGON'S PREGNANCY TEA

2 Parts Red Raspberry Leaf
1 Part Nettle Leaf
1 Part Alfalfa Leaf
1 Part Peppermint Leaf

If a woman has problems with anemia, I increase the nettle and alfalfa to 2 parts each. This tea is very healthful in supplying the pregnant woman (and breast feeding woman after the birth) not only hormonal support through the Red Raspberry Leaf, but also supplies a large variety of nutrients, such as iron and calcium to her diet as well as adding digestive support with the use of the peppermint. Sometimes I have used Comfrey as an additional herb for its healthful medicinal properties. Brew as usual using hot water and steeping. It has a great flavor and can be consumed without sweetener or by using a touch of honey as a sweetening agent. It is a great basic tea that other herbs can be added to during pregnancy to help other dietary needs or as a medicinal base for tinctures. It can be frozen into ice pops for use during labor. This tea makes great sun tea and can be mixed and made up in a glass gallon jar (I use an old pickle jar, well cleaned) and steep it in the sun during the summer months. The loose dry herbs can be placed in a couple of 4X4 gauze pads, opened up, placing the herbal mixture in the middle of the gauze and tied with a string or a rubber band. It can also be made using a standard drip coffee maker and coffee filters or using a "tea ball". Hot or Cold, this is a great tea for women of all ages, regardless of pregnancy or not. At least a quart of tea should be consumed throughout the day.

Be sure to obtain quality dried herb from a reliable source with rich color and aroma. Mountain Rose Herbs has a great line of bulk herbs at a reasonable cost. Shaman Shop also has a selection of hard-to-find herbal supplements and Herbal Remedies has a fine selection of products and supplements in capsules, tablets, liquids, powders and tinctures. See links further down on this page to visit these fine online stores.

As always, I recommend you consult with your midwife before taking any supplement, herbal or otherwise, during pregnancy. If you have any problems with this tea or it simply does not agree with you for any reason, discontinue use. However, in 27 years of midwifery, I have never had problems with a pregnant mom using this tea formulation.

Pernicious Anemia and low blood oxygen levels effects health of red blood cells. Herbal approach to treating anemia are the use of Kelp, Ginseng, Nettle, Rosehips, Rue, Yarrow, Comfrey, Echinacea, Red Clover.

Bach Flower remedies include Wild Rose, Sclerantthus, Gorse and Pine.

Yellow Dock root is a easily assimilated source of iron. Yellow dock contains only a small amount of this important mineral, yet herbalists consider it one of the most effective herbs for raising your iron level. Although the way that this herb increases iron remains a mystery, the proof is in the results. Many women with anemia and their health care providers have been amazed when yellow dock brought their iron count up to normal in only a few weeks. For some of these women, yellow dock brought up their iron levels permanently and they were able to discontinue using the herb. Others found that they needed to continue taking it to maintain their iron count at a healthy level.

Even if your anemia is so stubborn that it does not respond to yellow dock, a few additional herbs will usually do the trick. Studies conducted around the world have shown that the roots of Burdock, Sarsaparilla, Dandelion, cooked Chinese Rehmannia and Chinese Wild Yam increase the assimilation of iron, as do carrots and most green vegetables. (Although Chinese herbs like Rehmannia and wild yam were once restricted to the realm of Chinese medicine, they are now available in most natural food stores or bulk herbal suppliers.) German researchers were so impressed with how Anise, Caraway, Cumin, Peppermint and Linden Flowers improved iron absorption that they suggested that anyone with an iron deficiency drink tea made with at least one of these herbs. Iron-rich herbs include parsley, watercress and the seaweed dulse.

If these herbs seem like the ingredients for the start of a delicious soup or stew base, you're right! Throw in a few beet roots to add even more iron, and dine on this soup at least twice a week. The Chinese traditionally prescribe soups made from healing herbs like Rehmannia, wild yam and burdock. When you wish to incorporate medicinal herb roots into your meals, all you need to do is finely chop or grate them, then treat them like carrots. Caraway and cumin can also be used to spice up beans and vegetables.

IRON TEA

2 teaspoons Yellow Dock Root
1/2 teaspoon Nettle Leaves
1/2 teaspoon Dandelion Root
1/2 teaspoon Beet Root
1/2 teaspoon Licorice Root
1/2 teaspoon cooked Rehmannia Root (if available)
3 cups water

Bring herbs and water to a boil, then turn down heat and simmer for 5 minutes. turn off heat and let steep for 20 minutes. Strain out herbs. Drink 2 cups a day. This formula can also be taken as a tincture or in pill form. To take yellow dock by itself, you will want to use a tincture since the taste is so bitter.

For preventing anemia, take 1 tablespoon of yellow dock decoction or 25-40 drops of tincture daily. For treating anemia, use the same dosage as above but three times a day.

Caution: Do not take goldenseal or Oregon grape root during pregnancy. Do not take goldenseal for more than one week at a time, and use it only under a health care provider's supervision if you have a history of cardiovascular disease, diabetes, or glaucoma.

ALFALFA PRODUCTS

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Herbal Remedies: Alfa Max, Alfalfa Extract, Nature's Way, 525 mg, 100 Capsules

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Herbal Remedies: Alfalfa Tincture, 100% Organic, 2 fl. oz.

BILBERRY PRODUCTS

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Herbal Remedies: Bilberry Extract, Standardized, Nature's Way, 80 mg, 90 Caps

Herbal Remedies: Bilberry Leaf (Vaccinium myrtillus) Powder, 4 oz. Bulk

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DANDELION PRODUCTS

Mountain Rose Herbs: Dandelion, Bulk Herb

Herbal Remedies: Dandelion Root, Nature's Way, 540 mg, 180 VCaps

Herbal Remedies: Dandelion Root (Taraxacum officinale) Powder, 4 oz. Bulk

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GOLDENSEAL PRODUCTS

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HAWTHORN BERRY PRODUCTS

Mountain Rose Herbs: Hawthorn, Bulk Herb

Herbal Remedies: Hawthorn Extract, Standardized, Nature's Way, 500 mg, 90 Caps

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MULLEIN PRODUCTS

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Herbal Remedies: Mullein Leaf (Verbascum thapsus) Powder, 4 oz. Bulk

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NETTLE PRODUCTS

Mountain Rose Herbs: Nettle, Bulk Herb

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Herbal Remedies: Nettle Leaf (Urtica dioica) Powder, 4 oz. Bulk

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OREGON GRAPE ROOT PRODUCTS

Mountain Rose Herbs: Oregon Grape Root, Bulk Herb

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PAU D'ARCO PRODUCTS

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RED RASPBERRY PRODUCTS

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Herbal Remedies: Red Raspberry Tea, NOW Foods, 30 Tea Bags

SHEPHERD'S PURSE PRODUCTS

Mountain Rose Herbs: Shepherd's Purse, Bulk Herb

Herbal Remedies: Shepherd's Purse Herb Powder, 4 oz. Bulk

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YELLOW DOCK PRODUCTS

Mountain Rose Herbs: Yellow Dock, Bulk Herb

Herbal Remedies: Yellow Dock Root, Nature's Way, 500 mg, 100 Caps

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See banner links for Mountain Rose Herbs and HerbalRemedies.com near the bottom of the page to search for product links not included above or below.

HERBS TO AVOID

People who have anemia should avoid damiana, fennel, grapeseed extract, and rooibos. Herbs containing high concentrations of tannins interfere with the absorption of iron supplements. Avoid taking iron supplements within 2 to 3 hours of using agrimony, chebula, gambir, green tea, uva ursi, white willow bark, or any form of St. John's wort other than hypericin-standardized capsules or tablets.

TCM (TRADITIONAL CHINESE MEDICINE) FORMULAS

Four-Substance Decoction: A traditional Chinese herbal formula that treats all forms of anemia.

Si Wu Tang
[Four-Substance Decoction; Soup of Four Things; Tangkuei Four Decoction]

Class: Tonify
Subclass: Tonify the Blood
Source/Author: Tai Ping Hui Min He Ji Ju Fang (Imperial Grace Formulary of the Tai Ping Era)
Recipe:

Shu Di Huang (Radix Rehmanniae Glutinosae Praeparata) 35.70%
Bai Shao Yao (Radix Paeoniae Lactiflorae) 28.60%
Dang Gui (Radix Angelicae Sinensis) 25.00%
Chuan Xiong (Radix Ligustici Wallichii) 10.70%

Actions: Harmonizes the Liver. Moves Blood. Nourishes Blood.
Indications: Blood Deficiency, primarily of the Liver.
Symptoms: Amenorrhea; Anemia; Blurred vision; Dizziness; Dysmenorrhea; Irregular menstruation; Pain of the lower abdomen; Periumbilical pain; Postpartum weakness; Threatened miscarriage; Agalactia; Brittle nails; Dry nails; Dull complexion; Generalized muscle tension; Headache; Lochiometra; Pale complexion; Restless fetus disorder; Urticaria; Pale tongue; Fine-Choppy pulse (Xi Se); Fine-Wiry pulse (Xi Xian)
Preparation: DECOCTION: 40-50 g/liter until 40 cl remain.
Administration/Dosage schedule: DECOCTION: Take 3-4 times daily, before meals.
Contraindications: Acute and severe Blood loss (following hemorrhage, for example).

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HOLISTIC RECOMMENDATIONS

Include the following in your diet: apples, apricots, asparagus, bananas, broccoli, egg yolks, kelp, leafy greens, okra, parsley, peas, plums, prunes, purple grapes, raisins, rice bran, squash, turnip greens, whole grains, and yams. Also eat foods and drink juices high in vitamin C to enhance iron absorption.

Increasing intake of vitamin-C rich foods can enhance absorption of non-heme iron during a single meal, although regular intake of vitamin C does not appear to have any significant effect on iron stores. In any case, vitamin-C rich foods are healthful and include broccoli, cabbage, citrus fruits, melon, tomatoes, and strawberries. One orange or six ounces of orange juice can double the amount of iron your body absorbs from plant foods.

To combat anemia, it's important to increase your consumption of iron-rich foods and supplement with B vitamins and minerals like copper. Foods containing riboflavin (vitamin B-2-) may help enhance the response of hemoglobin to iron. Sources include liver, dried fortified cereals, and yogurt. The only natural dietary sources of B-12 are animal products, such as meats, dairy products, eggs, and fish (clams and oily fish are very high in B-12-); like other B vitamins, however, B-12 is added to commercial dried cereals. The recommended daily allowance (RDA) is 2.4 mcg a day. Deficiencies are rare in young people, although the elderly may have trouble absorbing natural vitamin B-12 and require synthetic forms from supplements and fortified foods.

Folate is best found in avocado, bananas, orange juice, cold cereal, asparagus, fruits, green, leafy vegetables, dried beans and peas, and yeast. The synthetic form, folic acid, is now added to commercial grain products. Vitamins are usually made from folic acid, which is about twice as potent as folate. Many experts now recommend that adults have 400 mcg of folic acid daily, which is considerably higher than standard recommendations of 400 mcg of folate, which does not take into consideration the possible benefits of folate on the heart. Low levels of folate during pregnancy are common without supplements; deficiencies at that time increase the risk of neural tube defects in newborns. Women who are planning to get pregnant should take 400 mcg of folic acid before conception as well as when they are pregnant or breast feeding.

Grape juice with no sugar or preservatives added is a wonderful source of iron. Drink 8 ounces every day.

Obtaining a juicer and making healthy juice drinks is a great way of getting unsweetened, pure, healthful fruit and vegetable juices. See MoonDragon's Therapeutic Liquids for more juicing recommendations.

MoonDragon's Nutrition Therapy: Juicing

Soak 10 currants overnight. Remove seeds and have for 3-4 weeks and have first thing in the morning.

Eat raw spinach salads often. Be sure to wash the spinach thoroughly. Combine any of the following in your spinach salad-water­cress, radish, kohlrabi, garlic, chives, leek and onion. They are all high in iron.

Daily intake of 3-4 pieces of dry figs helps in curing anemia.

Every morning after breakfast and every evening after dinner, eat two dried apricots. Snack on raisins.

Beet juice is the best anemia remedy. You can easily make this using a juicer. Carrots and other vegetables can be added for a raw veggie drink. Throw a few beet roots into your soup a few times a week.

Try to cook in cast iron pots and skillets. It is proven that doing it can significantly increases the amount of iron in your foods.

Honey is very good for an anemic person because it helps increase the hemoglobin in the blood. It is rich in iron, copper and manganese. Caution: Do not give raw honey to babies or very young children.

Iron rich meats may include salmon, mackerel, clams, oysters, mussels, sardines, anchovies, shellfish, organ meats such as liver, heart, tongue, beef, pork, lamb, poultry, and other fish.

Consume at least 1 tablespoon of Blackstrap molasses twice daily (for a child, use 1 teaspoon in a glass of milk or formula twice daily). Blackstrap molasses is a good source of iron, calcium, and essential B vitamins.

Eat foods containing oxalic acid in moderation or omit them from the diet. Oxalic acid interferes with iron absorption. Foods high in oxalic acid include almonds, cashews, chocolate, cocoa, kale, rhubarb, soda, sorrel, spinach, Swiss chard, and most nuts and beans.

Avoid beer and other alcoholic beverages, candy bars, dairy products, ice cream, and soft drinks such as cola. Additives in these foods interfere with iron absorption. For the same reason, avoid coffee (which contains polyphenols) and black tea (which contains tannins). Avoid excessive bran since it contains phytic acid. Seeds also contain phytic acid that can impede the body's absorption of dietary iron.

Avoid alkalinizers and phosphates. They inhibit absorption.

Avoid or minimize your exposure to lead and other toxic metals such as aluminum, cadmium and mercury. Do not use aluminum cookware.

Have a complete blood test to determine if you have an iron deficiency before taking iron supplements. Excess iron can damage the liver, heart, pancreas, and immune cell activity and has been linked to cancer. Use iron supplements only under the supervision of a health care provider.

Because iron is removed through the stool, do not eat foods high in iron and/or iron supplements at the same time as fiber. Avoid using bran as a source of fiber.

If you are a strict vegetarian, watch your diet closely. Taking supplemental vitamin B-12 is advised.

Do not smoke. Avoid second hand smoke.

Take a daily Multivitamin. Do not take any iron supplement without consulting with your health care provider.

Do not take calcium, vitamin E, zinc, or antacids at the same time as iron supplements. These can interfere with iron absorption.

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HOMEOPATHIC TREATMENT & MEDICATIONS FOR ANEMIA

This information was obtained from: Hpathy.com. See their website for more helpful information regarding Homeopathic Treatments.

Ferrum metallicum [Ferr]: Iron is the great allopathic remedy for anemia from almost any cause. It is also a great homeopathic remedy, but it will not cure every case of anemia; careful individualization is necessary. When the patient has an appearance of full bloodedness or plethora, which is followed by paleness or earthiness of the face and puffiness of the extremities, then Ferrum will benefit. It is not the remedy for the anemia resulting from loss of fluids; that is Cinchona, or perhaps Natrum muriaticum. When Ferrum is indicated the mucous membranes are pale, more so than with Cinchona, and there is apt to be an anemia murmur in the veins of the neck. The patient is easily exhausted. Vomiting of food after eating may occur. The patient is constantly chilly and perhaps has an afternoon or evening fever simulating hectic fever. In very stubborn cases sometimes Ferrum phosphoricum may serve better than Ferrum metallicum. Schuessler recommends first Calcarea phosphorica, then Ferrum phosphoricum. In simple, uncomplicated chlorosis Ferrum is one of our best remedies. Hughes recommends Ferrum redactum 1x or 2X. Ludlam praises Ferrum et strychnia citrate 3X, Dr. Jousset, Ferrum aceticum or the Ferrum protoxalate, and Dr. Holcombe of New Orleans, used Ferrum phosphoricum. All these preparations of Iron may benefit cases of anemia and chlorosis; if so, it is by virtue of their similarity to the symptoms of the case, and not because one or the other preparation of Iron is a tonic in the allopathic sense. By giving the indicated preparation of Iron it removes the underlying dyscrasia giving rise to the anemic or chlorotic conditions and cures the trouble.

Herbal Remedies: Ionic Iron Supplement, With Concentrace, Trace Minerals, 2 oz.

Pulsatilla [Puls]: Pulsatilla is the great antidote to Iron, and hence is indicated in the anemic condition produced by large or continued doses of it. The system is relaxed and worn out; the patient is chilly and suffers from gastric and menstrual derangements. Thus the symptoms resemble closely those calling for Ferrum. The cause of the anemia must be sought for, and if the case comes from allopathic hands it is safe to infer that much Iron has been given and Pulsatilla will surely be the remedy. The Pulsatilla patient feels better in the open air. Dizziness on rising, absence of thirst, and the peculiar disposition will lead to the remedy. Cyclamen, which is similar in many respects, differ from Pulsatilla in dreading the fresh air. Cinchona is the chief remedy for anemia resulting from loss of fluids, as in lactation or hemorrhage, or from all exhausting discharges, such as menstrual flow, long-lasting diarrhea, and sexual excesses and loss of semen. The quality of the blood is actually poorer in cases calling for Cinchona. Special symptoms are heaviness of the head, loss of sight, fainting and ringing in the ears, pale sallow complexion, sour belching, poor digestion and bloated abdomen. The patient is sensitive to draughts of air yet wants to be fanned. Dr. George Royal thinks many physicians err in giving Cinchona too low in symptomatic anemia when much time has elapsed since the drain was made on the system. He finds the 30th productive of better results than the lower preparations. Natrum muriaticum is also a remedy for anemic and debilitated conditions due to loss of fluids, especially in women who suffer from menstrual disorders and in chronic cases with a dead, dirty-looking skin. Chininum arsenicosum is sometimes prescribed for anemia, not, however, on the totality of the symptoms, but because it is said to be "good for it." It has been found curative in certain cases of pernicious anemia. Acetic acid suits anemic nursing women, with waxy skin, and thirst.

Calcarea carbonica [Calc]: Almost any of the deeper acting constitutional remedies may be of use in anemic and debilitated conditions, and especially are the Calcareas useful. Thus we have Calcarea phosphorica as the remedy for the "green sickness," chlorosis of young girls, with a complexion like wax, alabaster lips and ears, a bright eye, and when they smile or laugh it is a sickly one. The face sometimes has a true greenish hue or a sallow one. In such cases the menses are apt to be too early and then calcarea phosphorica is well indicated for this condition. Calcarea carbonica is indicated by the psoric, scrofulous or tubercular diathesis and the general symptoms of the drug, by disgust for meat, craving for sour and indigestible things, swelling of abdomen, vertigo and palpitation on going upstairs. The patient is in a state of worry. Constantly imagining calamities. Alumina is also a remedy for chlorosis due to the scrofulous diathesis and from improper nourishment, such as occurs in some children brought up on artificial foods. Nux vomica, too, may be indicated in anaemic conditions when due to gastro-intestinal derangements. Plumbum has been recommended for inveterate chlorosis with obstinate constipation. Alumina also, being an antipsoric, is the remedy for anemic conditions about puberty, with abnormal craving for indigestible substances, such as slate pencils, chalk, etc.

Arsenicum [Ars]: This being a direct poison to the red blood corpuscles takes first rank in cases of pernicious anemia or in anemia due to a malarial of toxic influence. Dr. Blackley, of England, reported four cases of pernicious anemia cured with small doses of the remedy. It does not correspond to simple anemia so well. Its indications are excessive prostration considerable edema, violent and irregular palpitation, marked appetite for acids and brandy, extreme anxiety and rapid emaciation. There is irritable stomach and intense thirst. When the allopathic school uses Arsenic as a blood tonic, and Dr. Bartholow says, "it is one of the most valuable remedies in the treatment of chlorosis and anemia," it does so on strictly Homeopathic principles. Picric acid. The extreme prostration of pernicious anemia, with a heavy tired feeling all over the body, burning pains along the spine and aggravation from excitement indicate this remedy.

Helonias [Helon]: An excellent remedy in anemia and chlorosis. It suits especially anemia from prolonged hemorrhage in women enervated by indolence and luxury, or such as are worn out with hard work; they are too tired to sleep and the strained muscles burn and ache A characteristic modality is that the patient is better when the attention is engaged, hence better when the doctor comes. This anemia is associated with disturbances in the urinary and sexual organs. Tired, anemic, backachey females need Helonias, "It is one of the best blood makers that we have." (E. G. Jones.)

Aletris [Alet]: Chlorosis. "The China of the uterine organs." (Hale.) Tired dull, heavy, confused. Debility of females from protracted illness; no organic disease. Power and energy of mind and body are weakened.

Secale [Sec]: This remedy produces a progressives general anemia. It is shown by the peculiar cachexia of anemia, pale, bloodless, jaundiced color. By its effect on the blood corpuscles it produces a general anemia, threatening not only the life of a part, but vitiating the whole life of the bodily economy. It is a sort of a mechanical anemia.

Natrum muriaticum [Nat-m]: This is one of our best remedies in anemic conditions. There is paleness, and, in spite of the fact that the patient eats well, there is emaciation. There are attacks of throbbing headache and dyspnea, especially on going up stairs, constipation and depression of spirits, and consolation aggravates. With these symptoms there is much palpitation, fluttering and intermittent action of the heart. The hypochondriasis in these cases is marked. Scanty menstruation is frequently an indicating symptom. Kali carbonicum is one of the most important remedies in anemia, weak heart, sweats, backache, especially with female complaints.

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AYURVEDA &ANEMIA

This information was obtained from www.ayurvedahc.com. Please visit their website for more in depth information about Ayurvedic Treatment of ailments.

Anemia is a deficiency in the quality or quantity of one's blood. It is generally a pitta (fire) derangement. Generally the liver is involved, as bile enters the blood and thins it out. The refined eye of Ayurveda also notes that anemia, like most imbalances, can be caused by any of the three doshas. Vayu anemia is due to deficiency and/or malnourishment; Kapha anemia is caused partly by excess weight, congestion and edema. You can determine whether you have anemia by several factors, pale or lifelessness, low energy, low grade fever or burning sensation, irregular elimination or yellowish and scanty urine, indigestion, vertigo, fainting, fatigue, and women may notice a pale or scanty menstrual flow, or no flow at all., the inner part of the lower eyelid will have no redness to it and if you squeeze your hand into a fist for a few seconds and release, the blood will take a long time to return to the palm.

There are many causes for anemia, both dietary and lifestyle. Excess hot, sour and salty foods, and alcohol derange the blood. Malnutrition is another cause. A traumatic injury, pregnancy, excess menstruation or bleeding condition, febrile diseases, liver disorders and excess sexual indulgence can derange the kidneys, blood and ojas or life sap creating an anemic situation. For women, immediately after a menstrual cycle, blood building herbs are recommended.

GENERAL BLOOD BUILDERS: Organic milk from free range cows & boiled, black sesame seeds, pomegranate or black grape juice, molasses, sucanat (whole cane sugar) are all good foods. Iron supplements, vitamin A & E are useful only if taken with ginger or cinnamon to help assimilate the mineral. Chyavan prash, 2-3 tsp. twice daily with the warm milk, turmeric and ghee are all useful suggestions. A mild laxative is suggested to regulate the bowls, helping drain the excess bile from the liver; aloe vera gel and triphala are the gentlest treatments.

GENERAL HERBAL THERAPY: In addition to aloe and triphala, saffron, shatavari, manjishtha and punarnava are the main treatments.

GENERAL GEM THERAPY: Red coral (or any red stones like garnet or ruby) improve blood circulation, particularly for Vayu and Kapha doshas. Pearl or moonstone are good for Vayu and Pitta constitutions.

SPECIFIC TREATMENTS: Each constitution or dosha is suggested to follow their food guidelines.

MEAT: Ayurveda suggests using meat only as a medicine since meat does not actually rebuild and regenerate the cells and tissues. In the case of extreme weakness, such as advanced cases of anemia, red meat (or its substitutes like liver pills) and bone soups are useful to take until the anemia is treated.

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OTHER CONSIDERATIONS

Eating fish at the same time as vegetables containing iron increases iron absorption. Omitting all sugar from the diet increases iron absorption as well.

Iron-deficiency anemia should disappear when the underlying cause is corrected.

Health care providers can sometimes detect vitamin B-12 deficiency by measuring serum B-12 levels, taking a complete blood cell count, and doing a blood test called the Shilling test, which evaluates B-12 absorption. Persons with pernicious anemia must take vitamin B-12 sublingually (dissolved under the tongue), by retention enema, or by injection. This treatment must be maintained for life, unless the underlying cause of the deficiency can be corrected.

Hydroxyuria (Droxia), a cancer drug, may be prescribed for people with sickle cell anemia who are over the age of 18 and have experienced 3 or more crises in a one-year period. The drug eases symptoms, but is not a cure for the disease.

Over 75 percent of people undergoing chemotherapy experience some degree of debilitating fatigue, and over 60 percent list fatigue as their number one problem. Usually, this fatigue results from a form of anemia known as thrombocytopenia, in which red blood cell counts are greatly reduced, a common side effect of cancer treatment.

The American Academy of Pediatrics (AAP) recommends that children under one year old not drink cow's milk. Milk can cause anemia by interfering with iron absorption and possibly causing internal bleeding. The AAP published the results of a University of Iowa study that found the blood content in the stool of infants fed cow's milk was 5 times higher than children fed infant formula. Researchers concluded the amount of iron lost was "nutritionally important". MoonDragon recommends babies under the age of 1 year should be breastfed if at all possible rather than using baby formula. BREAST IS BEST! However there are situations in which breastmilk is not available or a mother is unable to breastfeed her baby due to an illness or medication she may need to take. If your baby must be fed a baby formula, research the brands and find one best suited for your baby. Don't be afraid to shop around and compare brands. Not all formulas are created equally.

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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).
Very Important
Blackstrap Molasses	Adults: 1 tablespoon twice daily. Children: 1 teaspoon twice daily.	An excellent source of iron and other important nutrients. See above under Holistic Recommendations.
Folic Acid	800 mcg twice daily.	Needed for red blood cell formation. Folic Acid (Vitamin B-9), 100% Natural, Nature's Way, 800 mcg, 100 Caps
Plus Biotin	300 mcg daily.	Needed for red blood cell formation. Biotin Coenzyme, 100% Natural, Nature's Way, 1000 mcg, 100 Sublingual Lozenges.
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. Iron Ionic Mineral Supplement, Fully Absorbable, 20 +/- ppm, 16 fl. oz., Ionic Iron Supplement With ConcenTrace, Trace Minerals, 2 oz., Iron Gluconate, Nature's Way, 18 mg, 100 Caps
Or Floradix Iron Plus Herbs	2 teaspoons daily.	Contains a readily absorbable form of iron that is non-toxic and from a natural source.
Vitamin B-12 (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. Vitamin B-12 Complex Liquid, Now Foods, 2 fl. oz.
Or Vitamin B-12	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-12 Complex Liquid, Now Foods, 2 fl. oz.
Important
Vitamin B Complex	50 mg 3 times daily.	B vitamins work best when taken together. A sublingual form is recommended. Ultimate B (Vitamin B Complex), Nature's Secret, 60 Tabs, Vitamin B-100 Complex, w/ Coenzyme B-2, Nature's Way, 631 mg, 100 Caps
Pantothenic Acid (Vitamin B-5)	50 mg 3 times daily.	Important in red blood cell production. Vitamin B-5 (Pantothenic Acid), 100% Natural, Nature's Way, 250 mg, 100 Caps
Vitamin B-6 (Pyridoxine)	100 mg daily.	Involved in cellular reproduction. Aids absorption of vitamin B-12. Vitamin B-6 (Pyridoxine), 100 mg, 100 Caps
Vitamin C	3,000-10,000 mg daily.	Important in iron absorption. Vitamin C Liquid w/ Rose Hips & Bioflavonoids, Kosher, Natural Citrus Flavor, Dynamic Health, 1000 mg, 16 fl. oz., Ester C With Bioflavonoids, Nature's Way, 1000 mg, 90 Tabs, Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps, The Right C, Nature's Way, 1000 mg, 120 Tabs
Helpful
Brewer's Yeast	As directed on label.	Rich in basic nutrients and a good source of B vitamins. Brewer's Yeast, Debittered, NOW Foods, 1 lb., Brewer's Yeast, NOW Foods, 650 mg, 200 Tabs
Coenzyme A Coenzyme A Technologies	As directed on label.	Supports the immune system's detoxification of many dangerous substances. Pantethine (Coenzyme A Precursor), Highly Active Form of Vitamin B-5, NOW Foods, 300 mg, 60 Softgels,
Copper	2 mg daily.	Needed in red blood cell production. Note: If more zinc is used, increase copper proportionately. Copper Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.
Zinc	30 mg daily. Do not exceed this amount.	Needed to balance with copper. Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz., Colloidal Silver & Zinc Lozenges, Silva Solution, 90 Lozenges, Zinc Lozenges W/ Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges, Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 Caps
Raw Spleen Glandular	As directed on label.	See Glandular Therapy for more information.
SAM-e (S-Adenosylmethionine)	As directed on label.	Helps reduce stress and depression. Caution: Do not use if you have manic-depressive disorder or take prescription antidepressants. SAM-e, Enteric Coated, NOW Foods, 100 mg, 30 Tabs
Vitamin A	10,000 IU daily.	Important antioxidant. Vitamin A, 10,000 IU, 100% Natural, Nature's Way, 100 Softgels
Plus Natural Beta-Carotene	15,000 IU daily.	Important antioxidant. Beta Carotene (Natural Dunaliella Salina), Nature's Way, 100% Natural, 25,000 IU, 100 Softgels, Multi-Carotene Antioxidant, Nature's Way, 60 Softgels
Or Carotenoid Complex (Betatene)	As directed on label.	Important antioxidant. Beta Carotene (Natural Dunaliella Salina), Nature's Way, 100% Natural, 25,000 IU, 100 Softgels, Multi-Carotene Antioxidant, Nature's Way, 60 Softgels
Vitamin E	200-600 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 assimilation. Use d-alpha-tocopherol form, if available. Vitamin E, D-Alpha-Tocopherol, Nature's Way, 400 IU, 100 Softgels, Vitamin E, Mixed Tocopherols, Unesterified, 400 IU NOW Foods, 250 Softgels, Vitamin E, DL-Alpha-Tocopherol, Hypoallergenic, Allergy Research Group, Nutricology, 400 IU, 120 Softgels

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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.

Alfalfa Leaf Root Powder (Medicago Sativa), Kosher, 4 oz. Bulk Alfalfa's (Medicago sativa) deep root system pulls valuable minerals from the soil. With the aid of sunlight, nutrients including beta carotene and chlorophyll are made available to the body in a usable form.

Alfalfa Leaves, Nature's Way, 405 mg, 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.

Alive! Whole Food Energizer Multi-Vitamin with Mineral, Nature's Way, 18 mg 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.

Alive! Whole Food Energizer Ultra Multi-Vitamin Powder Shake Mix With Soy Protein, Vanilla, Nature's Way, 2.2 lb. Alive Ultra Shake multi vitamin is the ultimate source for nutritional energy. In addition to being a comprehensive whole food multivitamin it has the added benefit of Solae soy protein. There are more invigorating nutrients from more natural sources in each serving than are contained in any other supplement.

Amalaki (Dhatri), 100% Natural, 450 mg, 120 VCaps Amalaki is an Ayurvedic effective against allergies, anemia, cold & flu, constipation, diabetes, digestive disorders, and liver problems.

American Ginseng Root Candy, Prince of Peace, 5.3 oz. American Ginseng, an adaptogen with yin properties that has a sedative effect on the central nervous system.

American Ginseng Whole Root (Panax Quinquefolium), 4 oz. Bulk Ginseng is considered to be the King of all Tonics; as it provides stimulation to the entire body for stress, fatigue, weakness, and deficiencies. It stimulates and improves the brain cells and is especially stimulating for mental fatigue.

Anemia Tincture, 2 fl. oz. Used for anemia, sore throat, helps to cleanse and build the blood.

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.

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.

Beet Root, Nature's Way, 500 mg, 100 Caps Nature's Way use only selected Beet Root from prime North American sources.

Beta Carotene, Natural Dunaliella Salina, 100% Natural, Nature's Way, 25,000 IU, 100 Softgels Nature's Way Beta Carotene is 100% all natural from Dunaliella salina.

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.

Biotin Coenzyme, 100% Natural, Nature's Way, 1000 mcg, 100 Sublingual Lozenges Biotin is an enzyme cofactor which assists in the release of energy from carbohydrates and in the production of fatty acids. It also assists in activating the energy transfer molecule ATP.

Black Cherry Fruit Extract, NOW Foods, 750 mg, 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.

Blood Circulator, 100% Natural, Jingul Huayu, 450 mg, 60 Caps This time-honored formula is used in Chinese medicine to promote micro-circulation, increase blood flow to heart muscles, open and clear arteries, inhibit intestinal adhesion, soothe the liver, remove stasis and maintain healthy blood circulation and regular menses.

Brewers Yeast, NOW Foods, 650 mg, 200 Tabs Brewer's Yeast has been shown to help people having difficulty sleeping, fatigued, and diarrhea caused by Clostridium difficile.

Chlorofresh, Chlorophyll Supplement, Nature's Way, 50 mg, 90 Softgels Chlorofresh, Chlorophyll Supplement, is used chiefly as an aid to reduce odor from a colostomy or ileostomy and to reduce fecal odor due to incontinence.

Chlorofresh Liquid Natural, Nature's Way, 16 fl. oz. Chlorofresh is a special liquid chlorophyll complex, derived from premium alfalfa leaves. Chlorofresh is used chiefly as an aid to reduce odor from a colostomy or ileostomy and to reduce fecal odor due to incontinence.

Cobalt Ionic Mineral Supplement, Fully Absorbable, 30 +/- ppm, 16 fl. oz. WaterOz Ionic Cobalt is a pure liquid Cobalt supplement. Cobalt is an important agent of Vitamin B-12; it increases the body's ability to absorb it.

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.

Colon & Liver Cleanser, Truman's CAC Tea, Loose Leaf, 1/2 lb. Use of this cleansing tea has many additional benefits: improves overall digestion; strengthens the immunity; helps to prevent cancer; makes the skin more emollient and flexible: clears the eyes; and provides an overall tonic effect on the body.

Comfrey Leaf Powder, 4 oz. Bulk One of the most well-known healing plants, especially for its ability to heal tissue and bone.

Comfrey Leaf Tincture, 2 fl. oz. Comfrey contains allantoin, which promotes the growth of connective tissue, bone, cartilage, and is easily absorbed through the skin.

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.

Dandelion Root Powder (Taraxacum Officinale), 4 oz. Bulk Dandelion root is known as a Blood purifier used for liver and kidney disorders. Dandelion root also contains nutritive salts to build up the blood.

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 post-menopausal women.

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.

Ester C with Bioflavonoids, Nature's Way, 500 mg / 200 mg, 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.

Folic Acid (Vitamin B-9), 100% Natural, Nature's Way, 800 mcg, 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.

Food Grade Diatomaceous Earth (DE) Powder, 8 oz. This Food Grade Diatomaceous Earth is safe and nontoxic and destroys intestinal parasites physically by injuring them.

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; Wounds

Hawthorn Berries, Nature's Way, 510 mg, 180 VCaps Hawthorn berries of this European species have been used since ancient times for well-being and as a cardiovascular tonic.

Heart Formula Tincture, 100% Organic, 2 fl. oz. The Heart Formula can be used for anemia, fatigue and heart problems.

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.

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.

Iron Complex w/ Vitamins & Herbs, Vegetarian, NOW Foods, 250 Tabs Now Foods utilizes the superior Albion Labs patented Ferrochel iron chelate which research has shown to be highly absorbed, well tolerated, and non-constipating at recommended levels.

Iron Gluconate, Nature's Way, 18 mg, 100 Caps Nature's Way Iron gluconate is an advanced chelate form which provides superior absorption and it contains no artificial ingredients or preservatives.

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.

Kidney Support Wellness Oil, 2 fl. oz. Kidney Support Wellness Oil was designed to promote the health of your kidneys.

Kids Superfood Powder, Chocolate Flavor, Children's Supplement, 200 g. The SuperFood Children's Supplement has 33 fruits and vegetables with a healthy scoop of cocoa to bring a new and tasty way for kids to get the anti-oxidant power of 3 servings of fruits and vegetables in one glass.

Maca Powder (Lepidum Meyenii), 4 oz. Bulk Today Maca root is used to increase energy and support the immune system. Alternative Health & Herbs Remedies Maca Powder can help a number of conditions from fatigue to frigidity.

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.

Meta C Vitamin C Supplement, 1000 mg, 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.

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.

Ola-Loa Childrens Multi-Vitamin Drink Mix, Cran-Raspberry, 30 Packets Better your kids health by introducing them to this Child Multi-Vitamin based upon the most up-to-date studies on nutrition and child development and is 100% all-natural.

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.

Oregon Grape Root (Wild) Tincture, 2 fl. oz. Oregon Grape Root is used in liver deficiency, constipation, poor fat and protein metabolism, and general blood cleansing.

Pantothenic Acid, 100% Natural Vitamin B-5, Nature's Way, 250 mg, 100 Caps Nature's Way Pantothenic Acid, Vitamin B-5, is 100% natural calcium pantothenate. It contains no artificial ingredients or preservatives.

Pau D Arco (Purple Lapacho), Inner Bark, 545 mg, 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.

Potassium Ionic Mineral Supplement, Fully Absorbable, 340 +/- ppm, 16 fl. oz. WaterOz Ionic Potassium is a pure liquid Potassium supplement. Potassium aids rheumatic or arthritic conditions and is vital for the elimination of wastes.

Red Raspberry Leaves, 480 mg, 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.

Rhodiola Root Extract, Standardized To Minimum 3% Rosavins & 1% Salidrosides, NOW Foods, 500 mg, 60 VCaps Today, Rhodiola root extract is a commonly used herb to boost the immune system and boost energy levels naturally and supports memory and mental clarity.

SAM-e, Enteric Coated, NOW Foods, 100 mg, 30 Tabs SAM-e was discovered in 1952 in Italy and has been researched and manufactured there. SAM-e works closely with folic acid and vitamin B-12.

Seabuckthorn Seed Oil, 100% Natural, 500 mg, 60 Softgels A rare source of vitamin E, Seabuckthorn Oil also provides other vitamins including Vitamins A, C, D, K, etc, carotenoids, flavonoids, phytosterols, amino acids, serotonin and 28 trace elements: iron, zinc, calcium, magnesium, selenium, iodine, etc.

Selenium Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz. WaterOz Ionic Selenium is pure liquid Selenium supplement. Selenium promotes normal body growth, enhances fertility, encourages tissue elasticity and is a potent antioxidant.

Shepherd's Purse Tincture, 2 fl. oz. Shepherd's Purse is mainly used to stop bleeding of all kinds.

Spleen & Pancreas Formula Tincture, 100% Organic, 2 fl. oz. Use the Spleen & Pancreas Formula to strengthen and nourish the spleen and pancreas naturally.

St. John's Wort, Perika, 300 mg, 60 Tabs Nature's Way St. John's Wort is scientifically advanced to maintain a healthy emotional outlook.

Supreme Beijing Royal Jelly With Bee Pollen, 10 ml Vials, 30 Vials Beijing Royal Jelly with Bee Pollen is naturally dense in vitamins, minerals, enzymes, amino acids and much more.

TheraClear Anti-Parasite Formula, 120 Caps A regular natural detoxification program including TheraClear Anti Parasite Formula and a colon cleanser to promote proper elimination has been recommended by various naturopaths.

U O Clear (Ovarian Cyst & Fibroid Support), 500 mg, 60 Caps The herbs work synergistically to strengthen the body's natural capability of female systems self-cleaning functions, especially for uterus and ovary.

Vitamin A, 100% Natural, Nature's Way, 10,000 IU, 100 Softgels Nature's Way vitamin A is 100% natural from fish liver oil. It contains no artificial ingredients or preservatives.

Vitamin B-6 (Pyridoxine), 100 mg, 100 Caps Vitamin B6 (pyridoxine) is converted in the body to the main coenzyme responsible for amino acid and protein metabolism.

Vitamin B-12 (Cobalamin), 50 mcg & B-9 (Folic Acid), 400 mcg, 1 fl. oz. Vitamin B-12 (Cobalamin) helps to maintain a healthy nervous system and helps in the prevention of pernicious anemia.

Vitamin B-100 Complex With Coenzyme B-2, Nature's Way, 631 mg, 100 Caps A complete Vitamin B complex of 8 essential vitamins. B Vitamins are precursors of coenzymes involved in the conversion of cellular energy, manufacture of hormones and proteins, and repair and maintenance of nerve structures.

Vitamin C Liquid, with Rose Hips and Bioflavonoids, Kosher, Natural Citrus Flavor, 1000 mg, 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.

Vitamin C 1000 with Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.

Vitamin E, Mixed Tocopherols, Unesterified, NOW Foods, 400 IU, 250 Softgels Vitamin E is a major antioxidant and the primary defense against lipid peroxidation. Vitamin E is particularly important in protecting the body's cells from free radical/oxidative damage.

Yellow Dock Root, 500 mg, 100 Caps Yellow Dock root is one of the best blood cleansing herbs for chronic skin diseases, purges lymph glands, liver ailments, psoriasis, anemia, rheumatism, coughs and helps with Iron deficiency.

Zinc Chelate, 100% Natural, Zinc Supplement, Nature's Way, 30 mg, 100 Caps Yellow Dock root is one of the best blood cleansing herbs for chronic skin diseases, purges lymph glands, liver ailments, psoriasis, anemia, rheumatism, coughs and helps with Iron deficiency.

FOR PETS HEALTH

Nu-Pet Canine Chewable Wafers, Vitamins & Antioxidant Formula, Ark Naturals, 270 Wafers Nu-Pet Canine Chewable Wafers provide vitamins, minerals, antioxidants, with a taste your pet is sure to love. Nu-Pet Canine Chewable Wafers are low in calories (a special benefit for overweight dogs) and are formulated by nutritional scientist using only the best all natural ingredients.

Nu-Pet Canine Chewable Wafers, Vitamins & Antioxidant Formula, Ark Naturals, 90 Wafers Nu-Pet Canine Chewable Wafers provide vitamins, minerals, antioxidants, with a taste your pet is sure to love. Nu-Pet Canine Chewable Wafers are low in calories (a special benefit for overweight dogs) and are formulated by nutritional scientist using only the best all natural ingredients.

Herbal Remedies: Anemia Information Herbal Remedies: Anemia Supplements & Products

NOTIFY YOUR MIDWIFE OR HEALTH CARE PRACTITIONER IF...

You or a family member has symptoms of anemia.

Symptoms do not improve in 2 weeks, despite treatment.

Symptoms of infection (fever, chills, and muscle aches) occur during treatment.

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MOONDRAGON'S RELATED LINKS



MoonDragon's Nutrition Information: Folic Acid Facts

MoonDragon's Pregnancy Information: Folic Acid Foods

MoonDragon's ObGyn Pregnancy Information: Birth Defects

MoonDragon's ObGyn Pregnancy Information: Spina Bifida

MoonDragon's Health & Wellness: Anemia Overview

MoonDragon's ObGyn Health Information: Anemia Index

MoonDragon's Birthing Practice Guidelines For Anemia

MoonDragon's ObGyn Information: Anemia During Pregnancy

MoonDragon's ObGyn Information: Anemia, Iron Deficiency

MoonDragon's Anemia, Nutritional, Herbal, & Holistic Recommendations

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MoonDragon's ObGyn Information: Sickle Cell Anemia

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