1. Hematological System KNH 413

2. Nutritional Anemias Macrocytic – Folate, Thiamin, B12 Decreased ability to synthesize new cells and DNA Microcytic – Protein, Iron, Vitamin C, Vitamin A, and Manganese Impaired heme synthesis Hemolytic- Deficiency or excess of Vitamin E

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

5. Normal blood smear Iron-deficiency anemia

7. 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

8. 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

9. Microcytic Anemias Iron deficiency Infants and children “Milk anemia” Childhood obesity Iron-poor food choices Pregnancy Fetal needs precede maternal needs © 2007 Thomson - Wadsworth

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

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

12. Microcytic Anemias Disease states associated with iron-deficiency anemia: HIV/AIDS GI disease Anorexia nervosa PKU

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

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

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

18. Microcytic Anemias Treatment/Nutrition Therapy Supplementation – single vs. multivitamin Females 15-60 mg if iron deficient Pregnant women - 30 mg Weekly doses vs. daily

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

20. Microcytic Anemias InterventionsInterventions –Enhance absorption with vitamin C –Increase intake of animal sources –Bioengineering –Community level

22. Megaloblastic Anemias RBCs have decreased capacity for oxygen transferRBCs have decreased capacity for oxygen transfer –Large, irregular, immature Pernicious anemia –Pernicious anemia – –Specific to GI disorders

24. Megaloblastic Anemias Elderly, pregnancy, atrophic gastritis, chronic alcohol consumption at highest riskElderly, pregnancy, atrophic gastritis, chronic alcohol consumption at highest risk Gastrectomy and bariatric surgeryGastrectomy and bariatric surgery –Intake, digestion, absorption InflammationInflammation Uracil accumulatioUracil accumulatio

26. Megaloblastic Anemias Clinical ManifestationsClinical Manifestations –Irritability, pallor, pale sclera –Chromosomal damage –Homocysteinemia

27. Megaloblastic Anemias Treatment/Nutrition TherapyTreatment/Nutrition Therapy –Oral cyanocobalamin and supplemental folate –Treat underlying causes –Patient education on nutrient density

28. © 2007 Thomson - Wadsworth

30. Megaloblastic Anemias Nutritional Implications/InterventionsNutritional Implications/Interventions –Elevated homocysteine in children and adults –Encourage animal foods if appropriate