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Red Blood Cell Function and Disorders of Iron Metabolism

    • Iron deficiency should be understood as a stage in the spectrum of negative iron balance. Negative iron balance exists when the body’s iron requirements exceed iron supply. Iron is needed to restore basal physiologic loss from exfoliated skin or mucosal cells, which is approximately 14 µg/kg/day.
    • For blood donors, each donation results in the loss of 200 to 250 mg of iron.33 During periods of growth in infancy, childhood, and adolescence, iron requirements may outstrip the supply of iron available from diet and stores. In addition, children fed whole cow’s milk may develop gastrointestinal bleeding, leading to iron deficiency.
    • A decreased serum ferritin concentration is the most specific indicator of iron deficiency. A serum ferritin concentration below 15 to 20 µg/L is diagnostic of absent or nearly absent iron stores, regardless of the laboratory methodology used. In contrast, a normal serum ferritin concentration does not confirm the presence of storage iron because serum ferritin concentration may be increased independently of body iron by infection, inflammation, liver disease, malignancy, and other conditions.

Red Blood Cell Function and Disorders of Iron Metabolism

    • Iron deficiency should be understood as a stage in the spectrum of negative iron balance. Negative iron balance exists when the body’s iron requirements exceed iron supply. Iron is needed to restore basal physiologic loss from exfoliated skin or mucosal cells, which is approximately 14 µg/kg/day.
    • For blood donors, each donation results in the loss of 200 to 250 mg of iron.33 During periods of growth in infancy, childhood, and adolescence, iron requirements may outstrip the supply of iron available from diet and stores. In addition, children fed whole cow’s milk may develop gastrointestinal bleeding, leading to iron deficiency.
    • A decreased serum ferritin concentration is the most specific indicator of iron deficiency. A serum ferritin concentration below 15 to 20 µg/L is diagnostic of absent or nearly absent iron stores, regardless of the laboratory methodology used. In contrast, a normal serum ferritin concentration does not confirm the presence of storage iron because serum ferritin concentration may be increased independently of body iron by infection, inflammation, liver disease, malignancy, and other conditions.

Motor Neuron Diseases

    • The genetic advances of the early 1990s and the subsequent development of disease models have propelled the field forward. Since then, there has been an exponentially increasing rate of genes discovered to be associated with ALS. More than 25 genetic abnormalities have been identified to cause disease, some of which have also been implicated in PLS and PMA.
    • Because only a small proportion of ALS is familial, and because the commercially available gene testing covers only a portion of the causative genes for ALS, genetic testing cannot be used to exclude a diagnosis of ALS. However, patients with a family history of ALS should receive genetic counseling and be offered genetic testing to identify a causative mutation. 
    • There is an ongoing effort to uncover markers of disease in the blood, CSF, urine, or other body fluid in patients with ALS. The discovery of a diagnostic biomarker for ALS could reduce diagnostic delay, and a biomarker of disease progression could serve as an outcome for trials.

Motor Neuron Diseases

    • The genetic advances of the early 1990s and the subsequent development of disease models have propelled the field forward. Since then, there has been an exponentially increasing rate of genes discovered to be associated with ALS. More than 25 genetic abnormalities have been identified to cause disease, some of which have also been implicated in PLS and PMA.
    • Because only a small proportion of ALS is familial, and because the commercially available gene testing covers only a portion of the causative genes for ALS, genetic testing cannot be used to exclude a diagnosis of ALS. However, patients with a family history of ALS should receive genetic counseling and be offered genetic testing to identify a causative mutation. 
    • There is an ongoing effort to uncover markers of disease in the blood, CSF, urine, or other body fluid in patients with ALS. The discovery of a diagnostic biomarker for ALS could reduce diagnostic delay, and a biomarker of disease progression could serve as an outcome for trials.

Motor Neuron Diseases

    • The genetic advances of the early 1990s and the subsequent development of disease models have propelled the field forward. Since then, there has been an exponentially increasing rate of genes discovered to be associated with ALS. More than 25 genetic abnormalities have been identified to cause disease, some of which have also been implicated in PLS and PMA.
    • Because only a small proportion of ALS is familial, and because the commercially available gene testing covers only a portion of the causative genes for ALS, genetic testing cannot be used to exclude a diagnosis of ALS. However, patients with a family history of ALS should receive genetic counseling and be offered genetic testing to identify a causative mutation. 
    • There is an ongoing effort to uncover markers of disease in the blood, CSF, urine, or other body fluid in patients with ALS. The discovery of a diagnostic biomarker for ALS could reduce diagnostic delay, and a biomarker of disease progression could serve as an outcome for trials.

Motor Neuron Diseases

    • The genetic advances of the early 1990s and the subsequent development of disease models have propelled the field forward. Since then, there has been an exponentially increasing rate of genes discovered to be associated with ALS. More than 25 genetic abnormalities have been identified to cause disease, some of which have also been implicated in PLS and PMA.
    • Because only a small proportion of ALS is familial, and because the commercially available gene testing covers only a portion of the causative genes for ALS, genetic testing cannot be used to exclude a diagnosis of ALS. However, patients with a family history of ALS should receive genetic counseling and be offered genetic testing to identify a causative mutation. 
    • There is an ongoing effort to uncover markers of disease in the blood, CSF, urine, or other body fluid in patients with ALS. The discovery of a diagnostic biomarker for ALS could reduce diagnostic delay, and a biomarker of disease progression could serve as an outcome for trials.

Surgical Palliative Care

    • National organizations such as the Trauma Quality Improvement Program of the American College of Surgeons have described the importance of palliative care integrated throughout the clinical course.
    • Increasing numbers of surgeons are fellowship trained and certified by the American Board of Surgery in Hospice and Palliative Medicine in addition to surgical specialties.
    • The importance of accurate prognostication for surgical patients and thoughtful communication of anticipated outcomes of different treatment plans has been recognized through frameworks such as the “Best Case/Worst Case” scenario.1
    • Structured descriptions of gaps and opportunities in the field promote future advancement and development of surgical palliative care.
    • Studies in surgical and nonsurgical patients demonstrate that palliative care, hospice enrollment, and lower-intensity end-of-life care do not decrease survival.

Surgical Palliative Care

    • National organizations such as the Trauma Quality Improvement Program of the American College of Surgeons have described the importance of palliative care integrated throughout the clinical course.
    • Increasing numbers of surgeons are fellowship trained and certified by the American Board of Surgery in Hospice and Palliative Medicine in addition to surgical specialties.
    • The importance of accurate prognostication for surgical patients and thoughtful communication of anticipated outcomes of different treatment plans has been recognized through frameworks such as the “Best Case/Worst Case” scenario.1
    • Structured descriptions of gaps and opportunities in the field promote future advancement and development of surgical palliative care.
    • Studies in surgical and nonsurgical patients demonstrate that palliative care, hospice enrollment, and lower-intensity end-of-life care do not decrease survival.
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