Hematological System KNH 413

Nutritional Anemias Macrocytic - Microcytic - Hemolytic Decreased ability to synthesize new cells and DNA Microcytic - Impaired heme synthesis Hemolytic Composition of blood used as diagnostic tool for disease presence, severity, or risk Macrocytic-B12, folate, thiamin, pyridoxine Microcytic- Protein, iron, vitamin C, A pyridoxine, copper, manganese Hemolytic- Deficiency or excess of vitamin E

Microcytic Anemias Iron deficiency Most common nutritional deficiency in U.S. Progression from negative iron balance to overt clinical iron-deficiency anemia Decreased RBCs, hemoglobin

Normal blood smear Iron-deficiency anemia

Microcytic Anemias Iron deficiency - etiology Blood loss; gastric ulceration, dysmenorrhea, inadequate intake… Functional anemia; oxygen is insufficient for erythropoiesis Depletion of iron in liver, spleen, other tissues results Iron can be measured from ferritin, hemosiderin, or transferrin

Microcytic Anemias Iron intake and absorption considerations: Poor intake with increased needs Food sources – heme vs. nonheme Vitamin C increases absorption Mineral excesses may bind iron Periods of rapid growth Phytates, tannins, polyphenols, may decrease absorption Contaminants such as lead

Microcytic Anemias Iron deficiency Infants and children © 2007 Thomson - Wadsworth Microcytic Anemias Iron deficiency Infants and children “Milk anemia” Childhood obesity Iron-poor food choices Pregnancy Fetal needs precede maternal needs Lactoferrin in breast milk, iron-fortified formulas—

Microcytic Anemias Iron deficiency Immunity Decreases immune function Zinc and vitamin A deficiency are confounding factors General malnutrition and repeated pregnancy with dietary deficiencies

Microcytic Anemias H. pylori infection Disease states associated with iron-deficiency anemia: H. pylori infection Cerebrovascular or cardiovascular disease Wounds, sepsis, surgery Impaired thyroid function Cancer

Microcytic Anemias HIV/AIDS GI disease Anorexia nervosa PKU Disease states associated with iron-deficiency anemia: HIV/AIDS GI disease Anorexia nervosa PKU Alcoholic Liver Disease Kidney Disease

Microcytic Anemias Special conditions that impact iron status: Athletes – esp. females Space flight – weightlessness Exposure to chemical or infectious agents

Microcytic Anemias Clinical Manifestations Cold extremities, pallor, fatigue, malaise, tachycardia Laboratory indices Measure of hgb often done alone Noninvasive point of care imaging

Microcytic Anemias Treatment/Nutrition Therapy Iron-dense foods Nutrient-dense diet long term Treat underlying condition

Microcytic Anemias Treatment/Nutrition Therapy Supplementation – single vs. multivitamin Females 15-60 mg if iron deficient Pregnant women - 30 mg Weekly doses vs. daily Side effects of supplementation- GI upset, constipation, nausea

Microcytic Anemias Nutritional Implications Fatigue, depression, difficulty in physical exertion – poor intake Depressed appetite

Microcytic Anemias Interventions Enhance absorption with vitamin C Increase intake of animal sources Bioengineering Community level Cook with cast iron Complimentary foods

Megaloblastic Anemias RBCs have decreased capacity for oxygen transfer Large, irregular, immature Pernicious anemia – Specific to GI disorders RBCs decrease O2 d/t folate, B12 deficiency Pernicious-result from stomach lining atrophy and inflammation

Megaloblastic Anemias Elderly, pregnancy, atrophic gastritis, chronic alcohol consumption at highest risk Gastrectomy and bariatric surgery Intake, digestion, absorption Inflammation Uracil accumulation Elderly Megaloblastic d/t poor intake B12, lack of intrinsic factor Gastrectomy- Megaloblastic d/t bacterial overgrowth Uracil d/t inadequate folate

Megaloblastic Anemias Clinical Manifestations Irritability, pallor, pale sclera Chromosomal damage Homocysteinemia Neuropathues- B12

Megaloblastic Anemias Treatment/Nutrition Therapy Oral cyanocobalamin and supplemental folate Treat underlying causes Patient education on nutrient density Weekly IM injections of B12 Pt education on foods high in B12 and folate

© 2007 Thomson - Wadsworth

Megaloblastic Anemias Nutritional Implications/Interventions Elevated homocysteine in children and adults Encourage animal foods if appropriate Educate against high soft drink consumption Increased use of fortified grain products